Personalized Medicine and The Pharmacist

The pharmacy profession has been an ever-changing field. The traditional lick stick and pour model no longer is the only role of a pharmacist; however, pharmacists are now the forefront of new research and innovative medicine development. We see the rise of several compounding pharmacies that focus on research into new effective drug delivery system. Take the development of an autologous eye drop for example. Patients with severe dry eyes no longer need to seek different artificial eye drop products, which they may also risk themselves from sensitivity from contained preservatives, instead, they can use their own blood to create the most suitable eyedrop for themselves. More study needs to be conducted on the eyedrops long term efficacy; however, this idea has widened many health care professionals view on the role of pharmacists.

The idea of using one’s own body material to make the most compatible drug has been extended into the field of pharmacogenomics. What if we can give patients drugs based on their genetic composition; thus choosing only those drugs that have the most benefit to the patient? Will patients be cured faster? Can we ultimately find a cure to cancer using pharmacogenomics? These questions are currently unanswered, but we are sure that not only does this method reduce the cost of trying different medications that might not work in the end, but also reduces the side effects from specific drugs and increase the efficacy of the drugs used.

Below is a discussion from my colleagues on the changing field of pharmacy and how pharmacogenomics can shape the future of pharmacy:

Our Changing Role

The pharmacy profession has strengths, weaknesses, opportunities and threats.  Pharmacists are an easily accessible resource in the community.  Pharmacists are very approachable to the public which can help to ease the strained health care system for those willing to take advantage of the free advice.  The business aspect of a pharmacy however, acts as a hindrance to the availability and time a pharmacist has to spend with individual patients and their concerns.  A pharmacist is responsible for numerous activities while on the job; from dispensing medications and medication management to ensuring prescriptions are safe for their patients – this doesn’t leave much time for individual consultations that could help to prevent potentially avoidable situations such as adverse reactions due to a simple interaction that could have been avoided by simply spacing the medications, for example.  There are however, many opportunities for pharmacists, such as finding individual specialties, such as geriatrics, to better serve the public’s concerns related to their particular niche of knowledge.  Threats to the pharmacy profession too however, are increasing.  One major threat to pharmacists are registered pharmacy technicians; they will be able to accomplish the dispensing job of the pharmacist, and unless pharmacists find a new niche in which to apply their skills and knowledge, pharmacists may no longer be necessary.  Increasing the importance of medication management and the role of counselling, as part of the major skill set for pharmacists will provide pharmacists the opportunity to branch out from their dispensing roles, to better serve the public.

As said by Mark Kunzli, there is an increasing number of threats to our profession.  At the same time, however, we have opportunities to avoid this impending “doom,” one of those opportunities being personalized medicine.  This involves tailoring the drug therapy to the individual genome of the patient.  For example, if the patient has Alzheimer’s disease caused by a mutation, we can identify the mutation and the associated mechanism of disease.  Then, we can pick a drug that works on the specific gene mutation to reverse the effects of the disease.

Personalized medicine is becoming a more viable option for many patients due to the decreasing costs of genome mapping.  The current price offered by Illumina is $4000; in comparison, scientists spent $3 billion sequencing the first human a decade ago.  As well, with the new investment by the Canadian government of nearly $70 million into pharmacogenomics research, we are hopeful that the reality of personalized medicine will be accessible to the public in the near future.

In light of these facts, we see that pharmacogenomics is a viable future for our profession.  As the sneaky pharmacy technicians try to “steal our jobs,” we can counter by creating our own niche of personalized medicine.  Since this is a relatively new field, it is up to us to promote it and protect it from the reaches of the other health professions.  We can promote it as the ultimate culmination of patient centred care.  With these advances, we will be able to predict accurately the pharmacokinetic and pharmacologic profile of drugs unique to each individual, which would tell us the exact effects, side effects, intensity, and duration.  With patient input along the way, we would be able to make the “perfect” pharmacy care plan.

 The Future~Pharmacogenomics

Personalized medicine is an interesting concept. It involves analyzing a patient’s genetic information to see what type of metabolizing enzymes are present, and to what extent they are present. The reason why this is important is because each individual will have varying degrees of metabolizing enzymes, which will in turn influence how they respond to a certain medication. Too much of an enzyme can result in extensive metabolism, reducing the half life of drugs to the point where there will be no clinical effect. Too little of an enzyme and the drug will stay in the system for far too long, resulting in unwanted adverse reactions. Surprising to note, is that the exact opposite can happen as well where too much of an enzyme can result in reactive metabolites, which can lead to additional side effects; and too little of an enzyme could prevent a prodrug from being converted into its active form. To even further complicate things, metabolic enzymes often have numerous substrates, so when one drug is present, it can affect other concomitant medications as well, leading to drug-drug interactions and ultimately side effects or decreased efficacy. The list goes on and on. This is what is referred to as pharmacogenomics, which is where pharmacists can potentially come into play. As noted above, the pharmacist role in the community has been gradually engulfed by pharmacy technicians, who will accept lower pay, thus making the pharmacist community obsolete. Pharmacists can expose this niche, not only to remain active in the job market, but to also provide excellent medication therapy. By analyzing one’s genetic information to find out what metabolic enzymes are present and how they will affect a patient’s medications, we can reduce the occurrence of side effects and increase the effectiveness of the drug.

Personalized Medicine is an exciting approach to healthcare that allows truly individualized management. Unlike the traditional model where clinical diagnosis uses laboratory test results, patient history and examination to diagnose and treat in a general way, Personalized Medicine applies genetic and other information to allow customized diagnosis and treatment specific to the patient and their problem.

Using this approach to patient care could lead to more targeted treatment resulting in less side effects, improved efficacy and ultimately, greater medication effectiveness. Maybe this how we finally get to the elusive goal of improved patient adherence – the final path in a virtuous circle where improved therapy leads to a better patient experience and so on.

I was interested to see the federal government just allocated $65 million for Personalized Medicine – I feel this is indicative of where things are headed.
I definitely feel Pharmacists should be actively involved in delivering Personalized Medicine. Pharmacist involvement could include interpretation of specific pharmacogenetic tests, especially when they impact drug dosages and pharmacodynamics.

 What’s Next

Pharmacogenomics is definitely the future of pharmacy and it is a field that will surely optimize the health care by pharmacists by customizing the therapy to the individual. Soon, general guidelines for treatment of certain major conditions like asthma will be obsolete. If used wisely for certain conditions or medications that have polymorphic effects and great variation in the population, pharmacogenomics can improve the efficacy, side effect profile and decrease the cost of therapy, thereby providing safe and effective patient health care.