Personalized Medicine and The Pharmacist

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

Personalized medicine is a type of medical model that utilizes an individuals genetic information to either predict disease susceptibility and/or optimize drug therapy. This process involves patients undergoing genetic sequencing and analysis. Analysis would compare the patients genetic code to known indicators of disease, by pin pointing specific genes that cause disease, or recognizing a series of multiple gene interactions to determine the prognosis. Information from the statistical data would indicate predisposition to certain diseases. Personalized medicine has the potential to completely change how several health care professionals approach diagnostics and treatment.Traditionally people are treated in a reactive manner (signs and symptoms lead them to seek medical care), but by having an understanding of which disease states one is predisposed to, proactive health measures can be undertaken. Patients are more likely be receptive to preventative measures after receiving  genetic diagnosis, knowing that they have the ability to increase their chances of a positive outcome vs. a potential of life long drug therapy or debilitation. Furthermore, personalized medicine has to ability to decrease the emotion burden that comes with a diagnosis that a patient has limited or no control over. It is important to consider patient compliance with taking an initiative and getting their genome sequenced. Misconceptions about confidentiality and discrimination would have to be addressed, and a cost consideration and potential for subsidization.  Patient compliance is a concern because patients may have mixed feelings about knowing their prognosis, especially for unpreventable diseases that appear later in life. The opportunity of targeted drug therapy is a further benefit of personalized medicine, as adverse drug reactions and toxicity would be preventable. Gene-centered research could also contribute to speed up the development of new therapeutic agents, this would be particularly useful in diseases such as cancer, or diabetes  in which the patients own cells could be used and modified to become reactivated or targeted towards fighting disease.

Since current health care is a collaborative effort, there is a definite role for a pharmacist in personalized medicine. Physicians can alter their focus to preventing disease, and pharmacists can work towards decreasing adverse drug reactions and making drug therapy more patient specific. The unique and specialized knowledge of drug therapy that a pharmacist has leaves pharmacists in the perfect position to implement personalized medicine into their practice. In an ideal situation, pharmacists would have access to a patients genetic information in the pharmacy so they could refer to it when checking the safety and efficacy of a new medication. However, it is unlikely that such widespread application of this technology will be available any time soon. In the more foreseeable future, we imagine pharmacists implementing personalized medicine in a hospital environment. Pharmacists would be trained to interpret genetic data and they could then apply their knowledge of a drugs pharmacokinetic properties to determine the ideal drug or ideal dose of a drug for a specific patient. We can see this being an efficient process, especially if the pharmacist and physician can work collaboratively in the initial prescribing of medication. This would reduce the amount of trial and error prescribing, and reduce the number of serious adverse drug reactions that are seen in certain populations. As one of the most accessible health care professionals that interact with a large number of patients a day, pharmacists are in a perfect position to promote personalized medicine to the public. They have the ability to educate patients and encourage them to support the idea of genetic testing to improve patient health outcomes.

Alesha Cvenkel, Shaylee Peterson, Charissa So, Emily Wharton, Sharon Liang, Kenji Nakajima and Kenji Kashiwagi

The question for topic one was “What do you think personalized medicine is? Do you think pharmacists should be doing personalized medicine?”

Personalized medicine means to me, in a broad sense, that patients receive optimal medication therapy based on their own personal situations. So this is a move away from “trial and error medicine” with first, second etc line therapies that get adjusted and changed based on a patient’s bad experiences (side effects, lack of compliance, whatever the issue may be) or lack of drug effect. Use of personalized medicine looks at a patient as a whole, incorporating a patient’s previous medications, current medications, other disease states, and finally their genetic profile into the decision making on what the best, safest and most effective drug therapy is for the individual.

Optimally, in a perfect world, I absolutely think pharmacists should be doing personalized medicine. We are the “drug experts”, and should thus be using current and previous knowledge and skills to the best of our abilities to make interdisciplinary decisions WITH the patient on the best therapy to fit them. However, with the status quo in pharmacy, personalized medicine is a difficult entity to get the ball rolling on. To start with, there are a lot of unknowns surrounding genetics still. The sequencing of the human genome was only done recently, and although there has been promise in certain drugs and their dosing, such as codeine, warfarin and anti-cancer drugs, there might still be more to learn about these genetic polymorphisms and their consequences. Secondly, your average pharmacist does not have extensive knowledge of genetics. Although there is a course on pharmacogenomics here at UBC, there is bound to be additional information needed for pharmacists to assist in making the optimal choices for patient care, and pharmacists who graduated pre-human genome sequences likely did not get exposure to this kind of education. At the current moment, I don’t know of any additional training available for pharmacists to, for example, do a residency or clinical rotation in pharmacogenomic research. And finally, pharmacists are in a difficult situation with respect to pay scale and business models. At the current moment, most pharmacists (at least those outside of the hospital setting, as they are paid by government funds) are paid a salary by private sector corporations which own the pharmacies. These corporations are, as any other business, looking to make money. Money in a pharmacy comes from scripts filled, dispensing fees, and kickbacks from pharmaceutical (generic drug) companies. Without adequate financial support for expansion into additional fields such as pharmacogenomics, it will be difficult to get the ball rolling on this one as nobody wants to work for free and corporations, unless they see the value of this kind of service, are unlikely to pay the extra wages for specialized pharmacists if they are not bringing in money for the services. In a hospital setting, I think this kind of personalized medicine service has more promise. Warfarin therapy, in the small sliver of practice I have seen, is very labour intensive with frequent lab tests, frequent changes in dose, and can be dangerous to the patient resulting in ineffective therapy or dangerous bleeding consequences. If something such as this was introduced prior to a patient beginning warfarin therapy, I wonder if it would save on pharmacist and physician time and take some of the “guesswork” out of warfarin dosing.

Well that’s my thoughts on personalized medicine…anyone else want to weigh in?

Melissa Twaites