Personalized Medicine and The Pharmacist

Personalized medicine is the utilization of a particular patient’s genetic information yielding a more individualized approach to providing health care. This is interlinked with the field of pharmacogenetics, which focuses on how genetic information impacts a patient’s response to a drug. Using this individual genetic information, we would be able to customize drug therapies for each patient in terms of choosing the most effective and safest class of drugs and dosing information. This can be accomplished by assessing a particular patient’s metabolic profile with respect to a particular class of drugs. For instance, we would look into the isotypes of enzymes expressed in an individual patient that may be responsible for metabolizing this drug. Furthermore, we may look into the extent a particular enzyme or receptor (to which the drug may bind to) is expressed to account for not only the effectiveness of the drug but also potential adverse effects (i.e. receptor prevalence in non-target tissues). Ultimately, using an individual’s genetic information to tailor their drug therapy would optimize their health care.
Pharmacists would be an excellent breach into this world in terms of easily accessible health care. With proper training, and an increase in knowledge base, a new age of personalized medicine can be just beyond the horizon and the scope of pharmacy practice will be able to expand. Pharmacists could have access to their patients’ genetic identity and be able to identify potential problems in drug therapy. For example, if a patient lacks a certain enzyme in order to properly degrade and metabolize the drug while in the body, the levels of drug in the body may build and toxic levels may be reached. With prior knowledge that this enzyme is not coded in certain patients, a pharmacist would be able to circumvent the entire toxicity profile testing and simply change drug therapy. In many cases this would eliminate the trial and error period of therapies, where patients take different doses of drugs and their response is gauged. On a less dark note, pharmacists would be able to work more closely with physicians and maximize the gain from their patient’s drug therapy which would create a more individualistic, patient centered type of care.
As drug experts, we are really adept at understanding how drugs work and how the body handles the drug. This fits really well with personalized medicine. We can take our knowledge base and apply it to each individual. Pharmacists are able to interpret lab tests and turn that into clinical decisions. Pharmacists in different locations, such as in hospitals, have access to lab values of a patient. This makes personalized medicine very accessible. In addition, patients may also want to understand what these lab tests mean for their health. Patients, potentially, can meet with pharmacists to discuss their lab tests and best ways to manage their medicine. This can be one component of patient centered care. Pharmacists are more accessible than doctors and can provide patients with an understanding of their disease and treatment. This builds upon the pharmacist’s relationship with patient and adds another aspect to it. In addition to medication management and counseling, we can also counsel the patient on their personalized treatment. This includes how their genetics and their diseases interact and what they need to know in order to optimize their drug therapies.

An example of where genetics and personalized medicine is used is in the screening for abacavir hypersensitivity reaction for HIV patients. We can screen patients’ HLA-B*5701 to see if a patient is allergic to abacavir. This is beneficial as it increases safety for patients. Patients are able to avoid abacavir if the screening showed that they would be hypersensitive.(1)

Personalized medicine and pharmacogenomis offer an amazing opportunity for pharmacists to fully utilize their unique knowledge of drug therapy and expand their role in the health care system. Patients could be screened to determine the most effective drug therapy for particular disease states, and which drugs could lead to significant adverse effects. As one of our group members so eloquently put:
We are a collective.
We are the cogs in the machine that make the world run.
For the most part we are faceless. You walk past someone on the street and you never see them again. This is why, sometimes, it is hard to remember that all these cogs are individual.
Diverse.
Unique.
Distinct.
It is because of our differences that personalized medicine is relevant and required in the world today.
Personalized medicine is a way of looking at an individual and giving a treatment option that is tailored to their particular needs. Not everyone finds Tylenol effective for their headaches, or gets a rash when they take penicillin. Simple applications of this idea are being applied already, such as taking a patient’s medical history, family history, social situation into account when choosing the right therapy but the possibilities are endless as our ability to work more specifications, such as a person’s genetic code, into how we proceed with therapy.
Rather than treating a disease, we are now looking to treat a person.

Pharmacists should most definitely be involved in this process. If we are the medication professionals, then we should be taking charge and making sure that the medication will be the right one for this patient. If the time comes that we can be applying a person’s genetic code to how we are deciding what drug to give a person, then it is our expertise that will be needed to look at that code and interpret how we can best solve that patient’s issue with the most benefit, and least harm possible with the medication that is not only right for their condition but right for them.
If we are involved with this process we can be putting patients on fewer drugs, with fewer side effects, for a much affordable cost. It will raise adherence and a patient’s over-all quality of life.
Personalized medicine is one of the greatest possibilities in the future of all medical fields, and the $67.5 million dollars that Canada has just invested in the health care model is the first step on the path to a bright future.

::Group 17:: Thomas Bateman, Sunny Johal, Daisy Ji, Alexander Li, Clay Palmer, Nick Fleming::

(1)Genetic Screening to Prevent Abacavir Hypersensitivity Reaction: Are We There Yet? [Internet]. 2011 [cited 2012 Feb 1]. Available from: http://cid.oxfordjournals.org/content/43/1/103.full