Personalized Medicine and The Pharmacist

On Jan 31, 2012, the federal government pledged a sum of $67.5 million for furthering research into the field of personalized medicine.

Proponents of personalized medicine say it is likely to change the way drugs are developed, how medicines are prescribed and generally how illnesses are managed. They say it will shift the focus in health care from reaction to prevention, improve health outcomes, make drugs safer and mean fewer adverse drug reactions, and reduce costs to health-care systems.

From the CBC article ‘Personalized medicine’ gets $67.5M research boost

So, what is personalized medicine and how significant is it to have garnered such a considerable sum from the reserves of our government?

What is Personalized Medicine?

Personalized medicine involves individualizing a patients’ drug therapy based on the patient’s genome and their therapeutic needs. This idea explores new avenues of pharmaceutical care as it involves tailoring the right medication, dose, and regimen, for the patient, as per the more traditional roles of pharmacy and medical practice with a genetic twist:  Not every drug may be suitable for a patient because not every patient has the right genes involved in metabolizing the drug. For patients who have a variant gene for the metabolism of specific drugs, they could metabolize the drug too slowly and thus  be at a higher risk for drug toxicity, or they could metabolize a drug too quickly and not be able to achieve therapeutic effects in the body. Because of the complexity and variation in the human genome, it is hard to determine a drug therapy that is suitable for every individual. Personalized medicine would therefore be very beneficial to patients as it can ensure safe and effective drug therapy, and in turn improve patient compliance.
So how does personalized medicine compare to the more traditional form of medication management?  The conventional form of medication management in most clinical settings involves the following steps:

1. Look for an appropriate drug with minimal side effects and drug interactions
2. Deliver drug and wait
3. Observe for efficacy and side effects of the drug as they appear
4. Conduct lab tests and measure/interpret drug concentration and other relevant parameters
5. Individualize therapy based on the info gathered.

With the above steps, finding the appropriate medication is little more than trial and error. With personalized medicine, clinicians can start to individualize therapy even before the administration of the first drug.  Each individual responds differently to a drug since no one has the same number of metabolizing enzymes, drug targets or drug transporters in their body. By analyzing the genome of patients, these unique constituents will come to light. Clinicians can then respond accordingly by either altering concentration of the drug or choosing a different one altogether.

Should Pharmacists be Involved?

Pharmacists definitely have a role  in personalizing medicine for patients as part of their expanding scope of practice. Because pharmacists are drug experts, they are ideal candidates in optimizing patient health through personalizing medication for patients. However, the path to implementing personalized medicine is lengthy and requires a lot of work. Pharmacists would first need to be trained and educated on how to interpret results of genomic tests and utilize the results to determine a drug therapy that would best fit the patient. Pharmacists will then need to keep up with the rapidly evolving research behind personalized medicine. Moreover, in order for personalized medicine to be a role of the pharmacist, pharmacists need also be involved in the promotion of personalized medicine so that it becomes a necessary component in their practice.

It is also important to note the role that the patient plays in his or her own health care. The patient is the one who makes the final decision regarding their health at the end of the day. Before including personalized medicine as a part of the pharmacist’s scope of practice, we must be confident that we as pharmacists will be able to educate patients about the significance of their genes in relation to the success of their drug therapy. Education is key in making sure that patients have all the information they need in order to make an informed decision.

What Should They Be Doing?

With a lack in formalized education in pharmacogenetics, it is not surprising that the majority of respondents reported their understanding of pharmacogenetics as fair or poor (83%). Only 17% of respondents rated their understanding of pharmacogenetics as excellent, very good or good. Those participants who rated their knowledge as either excellent or very good were associated with the highest mean scores on knowledge assessment, which helps validate this perception as being accurate. One encouraging statistic was that those with less than 10 years of practice experience demonstrated the highest scores on pharmacogenetic knowledge assessment, which may represent the increased focus of pharmacogenetics in the pharmacy curricula across the nation, as well as the increased amount of information on pharmacogenetics over the past decade. Of note, this group of practitioners with less than 10 years of experience also had the highest level of interest in further pharmacogenetics education.
-From the article Knowledge of Pharmacists Regarding Pharmacogenetic Testing

Pharmacists hold a critical position in the success of genome-based medication therapy.  In many institutions, the role of pharmacists in the implementation of personalized medication program has already been confirmed. Pharmacists in these institutions are specially trained in pharmacogenomics and they utilize their expertise to make appropriate decisions in optimizing patients’ drug therapies.These pharmacists obtain and interpret genomic test results for certain medications, such as those for cancer, prior to administering the medication. The test results tell the pharmacist whether the patient has variant alleles that put them at a higher risk for severe toxicities. Armed with this information, both patient and pharmacist can work together to make the right decisions about the patient’s treatment. Thus, not only does pharmacist involvement in personalized medicine help ensure the safety of the population, it also has the potential to save costs. Although at its infancy, pharmacogenomic concepts have already been successfully applied in some hospitals to date, and in the future, personalized medicine will ideally be able to extend past hospital care and into the community.

Arthur L, Sarah L, Nicole T, Alana W, May W, Christopher Y, Mohan Z,  

As the techniques of isolating and analyzing genetic information are getting more advanced and mature, personalized medicine has become possible and is going to emerge as one of the most effective and safest approach to treat diseases in the future. Since every individual has a exclusive set of genetic makeup, the phenotype of  each person is unique and hence how a person responds to a drug is going to be different from others.  For example, different people have various degrees of drug metabolism. Some might metabolize a particular drug faster while others might be slower. The different rate of metabolism will lead to different drug responses in a population. Unfortunately,  traditional drugs can only target patients with responses within a certain reference range.  What about the ones that are falling onto the high and low ends? This will lead to adverse drug reactions to these individuals. To tackle this problem, personalized medicine can be made using genetic sequencing and analysis from each individuals. By identifying specific genes and level of protein expression,  each tablet or capsule that is dispensed to the patient is going to “tailor-made” (drug ingredients and dosage) in order to offer the most effective and safest treatment for every single patient.

However, to this stage, the primary drawback of personalized medicine is the cost. Genotyping tests requires resources, lab technicians and time. Considering our population is aging over time and in few decades, majority of that will be in the older age group which usually most cost would go into. This will definitely add more burden to our health care expense . In a long run, the cost of genotype analysis process has to be reduced in order to make personalized medicine to be feasible and popularize in the general public.

It is my humble opinion that the transition from the current mode of operation to one more geared towards personalized medicine is an inevitable yet difficult process.

Whether we like it or not, personalized medicine is already an integral part of the health care system. In fact, personalized medicine is in effect from conception all the way until death. As fetuses and embryos, pre-formed humans are already screened for genetic defects that may be included in the parents’ genome. During life, people are considered to be more at risk for certain illnesses on the basis of age, race, sex, living conditions, life style, and family history. The patient’s medical history is documented throughout his course of life, and also used to provide details regarding the patient’s health status. There is a growing trend of medicine geared towards the individual, and it is only going to expand as society pushes forward. As a major component of the health care system, it is only natural for pharmacists to be part of this increasing trend.

The inevitability of the pharmacists’ involvement in personalized medicine can be observed from the following reasons. First, as greater advances in technology are made, it is becoming easier to build genetic profiles for individuals. This, in effect, leads to the acquisition of more genetic data. The data can contribute to trends, and the trends can be used to predict illness. As the distributor of medication to fight illness, pharmacists will no doubt have to be familiar with such systems. Second, there is a gradual shift in the health field from dealing with acute conditions, to dealing with chronic illnesses. Going hand in hand with chronic illnesses is increased refills for prescriptions, resulting in increased contact and the building of patient relationships. As the pharmacist knows more about the patient with each interaction, it is only logical that his recommendations become directed at the patient’s particular situation. Third, with the introduction of regulated technicians, pharmacist will have to revaluate their role in the health care team. As dispensing duties are gradually being shifted to technicians, utilizing the pharmacist’s knowledge in delivering effective drug therapies will become increasingly important. Personalized medicine will become a very important facet of the new role of pharmacists.

However, despite the inevitability, the transitional process would likely be a long if not difficult one. As with most pharmacies, the pharmacist does not only play the part of a health professional, but also the part of a revenue generator. Revenue often comes from processing prescriptions fast, and doing things fast means less time for patient interaction. This can become a problem for personalized medicine in that unlike doctors, patients do not make appointments to see the pharmacist. Patients would rather like to get their prescriptions fast, instead of wait while the pharmacist tries to make the regimen “personalized” for the previous patient. This also ties into the next point of public image. To many members of the public, pharmacists are still not regarded in the same light as doctors. This means that as personalized medicine become more prevalent, patients would rather go to their doctors for the service instead of pharmacists. This problem would be compounded if doctors also felt the same way, and would rather not give up their piece of income to pharmacists. This leads into the last point of reimbursement. For the service to be conducted, some sort of fair reimbursement system must be set up. If the reimbursement is too low, pharmacies will not likely spend the time needed to conduct personalized medicine. If the reimbursement is too high, other health professionals will complain of unequal treatment. A delicate balance of all these issues described above and more must be achieved, before the pharmacy profession is ready to move on to delivering personalized medicine.

Let us know what you think.

Kevin Tai, Yi (David) Sun

Group 12

Pharmacogenetics is the study of how a person’s genetics will influence their response to a drug. Polymorphs in a person’s genes may cause differences in efficacy, risk of toxicity or risk of side effects with drug therapy between patients. Pharmacogenetic testing involves testing a person’s genes for specific polymorphs and tailoring their drug therapy to their specific characteristics. Using the SWOT analysis tool we will look at the strengths, weaknesses, opportunities and threats (SWOT) of pharmacists leading the way in the future of the emerging field of pharmacogenetics.

Pharmacists have a variety of strengths that would make them useful in the implementation of personalized medicine, another name for pharmacogenomics. Pharmacists are often called the most accessible healthcare providers, as any patient can walk in to speak with a pharmacist. Pharmacists therefore are able to develop relationships with the patients and establish trust. If pharmacists were to be involved in pharmacogenomics, this would allow the patients to see us take on a more clinical role and therefore improve the patient’s views of the role of the pharmacist. This also will help to extend and improve upon the relationship between the pharmacist and the patient through more through and insightful interactions. Additionally, through Pharmanet the pharmacists already have access to the patient’s medication history allowing us to give unique insight and details on the patients past drug therapies.  Pharmacists are known among other health-care providers as the drug experts. Pharmacists are trained to have an extensive knowledge of drugs and pharmacologic therapies. This strength makes the pharmacist a very useful player for the implementation of pharmacogenomics. The information we could provide to a team of healthcare professionals could be helpful in gathering information to make therapeutic decisions for the patient.

Despite such strengths we already possess, pharmacists also have weaknesses that must be addressed before these strengths can be utilized effectively. First, it is our weakness that pharmacists, as a group, do not possess a strong bargaining power in the government compared to other health care professionals such as physicians or nurses. This bargaining power is of critical importance in emerging field of pharmacogenomics and personalized medicine because pharmacists and the government must negotiate to establish a solid reimbursement method. At the moment, pharmacists are not reimbursed properly for a variety of services they offer such as over-the-counter medication counselling services. This is primarily due to not having an established reimbursement method. Pharmacists must take initiative to build this foundation in the field of pharmacogenomics and personalized medicine so that their work will be fully appreciated monetarily by the government.

In addition to our lack of strong bargaining power, pharmacy schools currently do not offer adequate training to pharmacy students or licensed pharmacists to work in field of pharmacogenomics and personalized medicine. Such lack of knowledge and skills must be addressed as soon as possible. Otherwise, we will face threats from other professionals or graduates from other faculties for our place in personalized medicine. We must prepare ourselves for the future and be proactive so that not only us, but also the general public will find us useful and relevant in the health care system.

There are many opportunities for pharmacists to be involved in pharmacogenomics. With the aging population of the baby boomers comes an increased demand for medical services and provides an opportunity for pharmacogenomics to become part of the health care system As the new regulated technicians start to practice in the community, pharmacists are constantly on the lookout to expand their scope of practice to a more clinical role. Pharmacists should take advantage of this new technology that is quickly developing before another profession does. Pharmacists are perfectly positioned to perform pharmacogenetic counseling sessions with patients. They are already sitting down with patients to do medication reviews in community and hospital pharmacies therefore pharmacogenomics counseling could be fit into those sessions. During medication management counseling sessions, pharmacists are already reviewing a patient’s full medication history therefore it seems natural to explain how their genetic makeup may influence their drug therapy. Pharmacogenetic counseling sessions have already been tested in a couple of hospitals therefore the protocol must simply be expanded into other hospitals and potentially extended into the community. Community pharmacist can receive lab tests online and meet with the patient in the community for a review of the results.

Pharmacist face and will face a variety of threats in the field of personalized medicine. As mentioned in weakness section, other graduates or professionals with background in biochemistry, genetics and bioinformatics could easily adapt their knowledge and skills to expand their scope of practice. In fact, they already have more extensive knowledge than pharmacist in such topics as genetics. If they take additional training about medications, they can easily replace us in the field of personalized medicine.

Another threat we can predict is the cost of the personalized medicine. This field is currently expensive. Having a pharmacist to analyse the data will only add to this already high cost. Therefore, we must find out way to work efficiently and find a cost-saving measure. Otherwise, the public and the government will not invest in the field of personalized medicine. Another solution to this potential threat is to prove that our work is unique and valuable to patients and to the health care system. We must prove that our work is actually cost-saving at the end of the day by, for example, reducing and/or preventing side effects. Unless we prove ourselves to be useful amongst these threats, we will not be able to exploit all the opportunities that we are given.

In conclusion there are many considerations that must be taken into account when assessing the pharmacist’s role within the realm of personalized medicine. We are educated to be the drug care experts, so it seems natural that we will be involved in personalized medicine. As the field of pharmacogenomics begins to expand, pharmacists will need to work with other healthcare providers to continue putting patient care above all. This blog post looked at the ways pharmacists will be able to help with personalized medicine, and the hurdles we would have overcome to provide optimal patient care in this field.

Jessica Beach, In Whang , Stacey Tkachuk, Jason Tan, Ryan Teo, Agnes Wu, Michelle Shih

Several barriers have been identified that need to be overcome before personalized medicine becomes commonplace.  We would like to discuss one barrier in particular: education.  Currently genetic technology is advancing at an amazing rate. However, there is not a large enough healthcare workforce that can make clinical applications with emerging genetic advances.   Currently pharmacogenetics seems to be taught sporadically in pharmacy programs, giving students just a taste.  It is doubtful that many students graduate with a BScPh degree feeling confident in clinically applying their limited pharmacogenetic knowledge.  Sufficient education to confidently apply pharmacogenetic principles is really only being given to select staff at well funded research hospitals that are in the early stages of implementing pharmacogenetic monitoring programs.  As more monitoring programs prove beneficial, more hospitals/healthcare centres are going to want to adopt pharmacogenetic monitoring and it is unrealistic that each hospital should have to provide extensive clinical pharmacogenetic training.

With the entry level PharmD program at UBC being in the early stages of development, we are left wondering if the enhanced curriculum will involve any additional clinical pharmacogenetic training.  If not, is it possible that a graduate program or continuing education certificate may be obtained that would completely prepare students to have an active role in a pharmacogenetic monitoring program?  Another possibility is adding another residency program that is dedicated to clinically applied pharmacogenetics.  A few key questions need to be addressed while considering pharmacogentics education:  are there currently individuals who would be able to implement and teach these programs?  Also, what are the job opportunities for individuals highly trained in clinical pharmacogenetics within B.C or even Canada?  How will this change in the next 10-20 years? The answers to the previous questions may provide insight into how long it may be before clinical pharmacogenetics is fully implemented into a pharmacy curriculum.

Like a good small business, the implementation of clinical pharmacogenetics within a curriculum will have to start small and expand upon success and demand.  A proposed timeline to consider:

1) a highly trained group of individuals with experience in implementing a pharmacogenetic monitoring system are hired by a hospital for a trial monitoring program.

2) Experienced individuals train small group of hospital staff.

3) Trial is successful, evaluation shows patient outcomes improved and program is financially sustainable.

4) Program expansion: this is where UBC could collaborate with the hospital offering a graduate program or residency that would train a sufficient amount of workers to fill the monitoring program’s needs.

To conclude, personalized medicine appears to be the way of the future but there is a lot of work still to be done by pharmacists and the medical profession as a whole before it becomes feasible and mainstream.

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

I see personalized medicine as a natural extension of the application of basic science to medicine. I don’t believe it’s a new phenomenon, but just the latest iteration in targeting the basis of disease. A hundred years ago and before, the practice of pharmacy included many “cure-alls”.  These remedies purported to help with hair loss to gout and everything in between and thus were not even personalized to the disease state of the patient, let alone standardized or adjusted for dose and regimen or even ingredients. As science progressed and the underlying causes of some of these diseases became better understood, the “cure-alls” were replaced by drugs targeting the causes (or at least specific symptoms) of diseases. Pharmacokinetics could be viewed as another form of personalized medicine that allows for dose adjustment of a drug for physiological factors in a given patient with a given disease. The newest pharmacogenetics tests that have been trialed for metabolic and other enzyme variants are essentially extensions and refinements of pharmacokinetics that aim to adjust drug dose (or guide alternative drug choice) based on the genetic factors that underlie some of those physiologic factors that were the basis for pharmacokinetic monitoring in the first place. Other physiological factors, such as renal failure, are often environmental rather than genetic but there are already tests available to distinguish these. For this reason, I see pharmacogenetic testing by pharmacists for the purposes of determining metabolic enzyme profiles (really, an extension of PK monitoring) as a very logical extension of the trend of refining drug therapy that has been going on for hundreds of years as our knowledge of the basis of disease and drug response to disease increases. It has the potential to minimize patient suffering and maximize therapeutic efficacy with little additional cost as genotyping becomes ever faster and cheaper. With the support of genetic counsellors, already in place, this may be extended even further in scope and in predictive value into the development of future disease states (although this raises other ethical issues). Identifying susceptibilities of infectious organisms or diseases such as cancer through genetic testing is also a very exciting area. (Written by Robyn)

Personalized medicine is in part due to the new innovation in pharmaceutics and medicine. Pharmacogenomics plays a big role in the future of such endeavour. As pharmacist, we are the safe guard of drug delivery and we are also the most accessible of all the health care professionals. In addition, in one of our classes, pharmacists are the most trusted people in the society. So, with all of these, what am I trying to get at? Well, as pharmacists, we are going to be a walking encyclopedia of drugs, or so I hope. New innovations in pharmacogenomics can allow us to see if an individual has some sort of characteristic that might affect the pharmacokinetics and pharmacodynamics of drug therapy. Some of these characteristic may include warnings if the individual is a fast/slow metabolizer of particular substrates of a particular enzyme. We can prevent adverse effects of drugs before the effects can even manifest. For example, if a person is a slow metabolizer of a drug secondary to the allele combination that he/she has for the drug’s enzyme, then there is a risk of toxicity and adverse reactions. As pharmacist, we can further contribute to the safeguard of drug safety. As we are the one of the most accessible health care professional, we can start counselling people if they have genetic conditions that might affect drug delivery. Also, since we are the most trusted people in the community, the patient will must likely listen to our advice and be more knowledgeable about their condition. In Canada, we have public health care which means that pharmacists have to lobby with the government to enable new programs that will correlate with the advances in pharmacogenomics. Knowledge in pharmacogenomics can enable pharmacist to be creative and develop a new niche for the profession; however, we have to be careful about overlapping with doctors’ duties. We don’t want them to feel that we are stealing some of their duties. We want to ensure inter-professional dynamics within the health care community. Also, in the past, pharmacists have shown to be not-the-best for lobbying. We have to advocate for ourselves to survive the shifts and changes within pharmacy (ie. technician regulation, lower generic rebates). If we are not creative about finding new roles, we might be left in the dust and lose our profession. In addition, we have to lobby for compensation for new roles that we might have to do. We cannot offer our services for free because then, our profession is not being recognized.

I think the idea of having pharmacists in charge of clinical pharmacogenetics service, in addition to the clinical pharmacokinetics service that most hospital pharmacist currently undertake, is a brilliant way of expanding pharmacist’s scope of practice. Clinical pharmacogenetics service (i.e. personalized medicine) “matches” individuals with drugs that are safest and most effective for the particular individual, based on his/her genotype. And as drug experts, we are in the perfect position to bring this concept from the research setting to practice. As Tim mentioned above, with changes happening so quickly around us, such as pharmacy technician regulation, reduction in generic rebate, and robotic dispensing machines, it feels as if what we do as a profession is slowly losing its “value” in the healthcare system. Although I initially see this as a negative change to the profession, I now see this as a necessary force in transforming pharmacy into a better, more useful, and more sustainable profession in the near future. Along with the plethora of advantages this change may result in (e.g. potential reduction/capping of the increasing healthcare costs and patients receiving safer and more effective drug therapy), this transformation will also allow us to practice, in the future, using the full extent of our knowledge, which I am excited about. I feel that the technical work that many pharmacists still perform hides what we can fully offer to the public. By making ourselves even more accessible than we are now, such as actively promoting medication management and clinical pharmacogenetics/ pharmacokinetics services, we can increase the public’s awareness of what pharmacists are capable of and contribute more in helping our society achieve better health outcomes (e.g. reducing hospitalization rates due to easily preventable adverse drug reactions).

When patients are given the same drug at the same dose, each patient responds to the drug differently. A big part of this is because each patient differs in their genetic makeup. For instance some patients are “poor metabolizers” while others are “extensive metabolizers” due to the differences in the genes encoding metabolizing enzymes. As a result, each patient may require a specific therapeutic regimen or specific drug therapy based on his or her genetics. Personalized medicine is medical treatment tailored to an individual’s genetic makeup. By sequencing an individual’s genome, it allows us to accurately predict which patients are more susceptible to disease, which ones will respond positively to treatment, and which ones will experience adverse effects. In doing so, doctor’s can select drug therapy that is more “personalized” to the patient’s genetic code. The initial role of a pharmacist in personalized medicine is to become educated in the field of pharmacogenomics. Since pharmacists are the drug experts, they are best suited to educate both patients and other health care professionals on pharmacogenomics and its significance in drug therapy. Pharmacists will need to be able to interpret pharmacogenomic data and be able to use this information to ensure optimal drug dosing. Ultimately, pharmacists will play a major role in developing “personalized” drug therapies based on a patient’s genome.

Moreover as we look to the future, the cost of sequencing the genome has gone down drastically in the past 10 years. The first successful sequencing of the human genome cost hundreds of millions of dollars. According to genome.gov as of October 2011 it costs approximately $8,000 to sequence a human genome. Considering that the average cost just 3 years prior was $10,000,000 this is definitely a step in the right direction for the implementation of a clinical pharmacogenomics service in the future as the trend is expected to continue. (http://www.genome.gov/images/content/cost_per_genome.jpg)

In fact, the speed at which the costs are going down are exceeding the expectations based on Moore’s law and this could allow genomic sequencing to be as routine as other lab tests in the near future. This will take personalized medicine to a literal sense, individualized care and therapeutic decisions based on a patients own unique genetic make up.

(1) Wetterstrand KA. DNA Sequencing Costs: Data from the NHGRI Large-Scale Genome Sequencing Program Available at: www.genome.gov/sequencingcosts. Accessed [date of access].

Group 8: Stephanie Hsieh, Rakesh Dewan, Godwin Cheung, Harman Toor, Kendra Stewart, Timothy de la Torre, Kuldeesh Grewal

Personalized medicine is the next major cornerstone of medicine.  It will allow health professionals to modify treatments for each patient to achieve optimal drug therapy and disease prevention.  Even today, it already has a major role in treating cancer patients. Since many types of cancers have specific sensitivities to certain drugs, health care professionals are able to use specific, personalized drugs to reduce side effects and enhance the efficacy of the treatment.

     It also presents a shift in our approach to provide health-care to patients.  Rather than reacting to the patient’s current illness, care can be provided to prevent these illnesses from occurring at all.  Prophylactic treatment has been proven to be less taxing on the health-care system by reducing hospital visits, and provides better outcomes for patients.  For pharmacists, there will be a greater emphasis on counseling patients to encourage patients to actively participate in pharmacological and nonpharmacological therapy.  In turn, with the help of a pharmacist, the patient may be able to avoid developing diseases and illnesses.

There are a number of implications with the shift towards personalized medicine. For patients, it could mean fewer side effects, shorter duration of therapy, lower drug costs, and better therapeutic outcomes. It could also mean better patient compliance, as patients may be more willing to take their medication knowing they can prevent lifelong diseases from occurring. For doctors, it could mean a shift from diagnosing a disease to preventing disease.  It could mean fewer patient visits and more phone calls/emails to patients to suggest lifestyle changes. It could also mean more office time spent analyzing patient genomes.

As for pharmacists, it means vigorous drug optimization to meet patient outcomes in the best way possible.  It also presents a huge business opportunity.

Ultimately, with the evolving role of pharmacy technicians, pharmacists must find a new niche in order to survive at the job market.  Of course, pharmacy technicians cannot provide therapeutic advice for the patient, but with less pharmacists being hired and more pharmacy graduates, pharmacists must create a new opportunity for themselves. Personalized medicine is one such opportunity.  Pharmacists might find a new role in analyzing a patient’s genome and making any changes necessary to a prescription to ensure optimal dosing if a patient may be susceptible to increased or decreased metabolism of the drug, leading to decreased or increased drug concentration in the body.  In addition, preventing drug interactions may be approached differently by analyzing a patient’s genome and understanding to what extent the drug interaction may imply on the patient.  Therefore, the pharmacist will be able to decide what’s best for the patient.

     Personalized medicine still has a ways to go.  While relatively inexpensive relative to perhaps just over a year ago, $1000 to sequence an entire genome for a patient may be cumbersome to most patients. Further reduction in costs is necessary to provide equal and fair opportunities for every individual. Education and training is important to provide competent healthcare professionals to properly administer personalized medicine. Furthermore, a major healthcare revamp must take place to provide electronic records and common records between health professionals.  Pharmacists are a very important part of the overall future of healthcare as medication management professionals.  We must take the opportunity and make pharmacogenomics a major role in the future of our profession.

Torey

Group 12