Personalized Medicine and The Pharmacist

Personalized medicine is a current and relevant  topic that has arisen from advancements in technology, specifically in regards to genome sequencing.  It involves genotyping individuals in order to predict specific health outcomes, such as the onset of certain diseases or how individuals will respond to different medical therapies.  Personalized medicine gives us the ability to target conditions early, allowing us to improve the chances of survival and decrease hospital stays, thereby reducing morbidity, mortality and long-term healthcare expenditures.  It also gives us insight into more efficient dosing regimens and the reduction of adverse drug effects, as genotyping can be used to predict responses to medications.  Personalized medicine has helped thousands of people thus far, but still remains sporadic in its distribution amongst healthcare facilities due to scientific, business, regulatory, and policy challenges.  It is our hope that these challenges will be overcome to push personalized medicine to become an accepted and widely used tool in healthcare.

A major concern with personalized medicine is its potential to aid in discrimination.  Employers and insurance companies may use sequenced genotypes in determining whether the individual is a suitable candidate to hire or insure. As a result, many individuals may be left without jobs or without private insurance due to their genetic predisposition for certain medical conditions.  As such, it is imperative that restrictions are put in place in order to control who is able to access information that is drawn from genotype sequencing. Based on the principles of patient autonomy and confidentiality, patients should be allowed full control over who is able to view their genetic information. Much like any other aspect of medical records, a patient’s genetic records need to be kept confidential if that is the patient’s desire and should not be accessed without their permission. Furthermore, the initiation of all genetic tests should only be done voluntarily and not through coercion or pressure from potential employers.

Given that personalized medicine has a direct effect on medication therapy management, it is natural that pharmacists should be heavily involved.  Pharmacists have specialized medication training and are experts in their field, giving them significant knowledge in terms of drug dosing, interactions, contraindications, and both positive and negative effects of medications.  This knowledge places pharmacists in the ideal position to take charge in managing new drug technologies and can be utilized in selecting and developing tailored treatments for individual patients based on predictions from their genome. This ultimately increases positive health outcomes such as the elimination of symptoms, the reduction of disease occurrence, and overall survival rates.

Since pharmacists have specialized training in medication management, it would be beneficial for teams of healthcare professionals as well as for patients to have pharmacists work alongside physicians for managing therapy with personalized medications – analogous to how pharmacists work alongside physicians to adjust dosing of warfarin in anticoagulation clinics. Just like how the pharmacists of today can interpret lab values, pharmacists of the future specialized in personalized medication would be able to interpret the genotyping tests and manage personalized medications accordingly.

On the flip side, the cost-benefit of ordering genotyping tests is questionable. Genotyping tests requires time, labour, and resources. While not all medical conditions or medications require genotyping tests, there needs to be some kind of standardized protocol to assess whether particular circumstances demand such a test, and whether such tests are practical given the constraints of current medical technology.

Group 3: Kelsey Lautrup, Chase Nickel, Nina Bredenkamp, Brittni Jensen, Anthony Le, Adam Amlani, Katie Wong