Personalized Medicine and The Pharmacist

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comments on the current pharmacy practice and personalized medicine

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1. Corporations create an environment incompatible with pharmacy practice


Large surface stores are modelled on high volume sales, low profit margins, simple products and low consumer interaction. Pharmaceutical care, on the other hand, centers around the needs of individual patients as well as complex and potentially dangerous technologies (i.e. pharmaceutical drugs). Selling warfarin in a one-stop location next to the toilet paper, chocolate and big screen televisions subconsciously conveys to the patient that their prescription is like any other consumer good; it should be cheap and it should be fast. This practice endangers the safety of the patient by trivializing the risks associated with pharmacotherapy and the information provided by the pharmacist during pharmaceutical counselling.


Additionally, the corporate environment imposes on the pharmacist unattainable goals which compromise pharmaceutical care. The performance of employed pharmacists is not assessed on their merits as good healthcare providers but rather on the number of prescriptions processed in any given day. Under such circumstances, medication review, pharmacovigilance, pharmaceutical counselling and continuation of care are set aside in order to maximize sales per hour.          


2. Corporations are inflexible entities


Pharmaceutical needs of individual patients are varied and unique. A given patient may require a compounded medicine, a veterinary product, a brand name medication, a prescription delivered after hours or simply social interaction. Such characteristics are incompatible with the inflexible large corporation model of chain-assembled goods. The real-life result is that patients are routinely refused pharmaceutical care, or referred elsewhere, due to high cost-to-profit ratios and time constraints. As pharmacy students, many of us have witnessed or heard about the atypical patient which the pharmacy staff would rather avoid servicing.        


3. Private enterprise stimulates quality of service and innovation


Pharmacy is unavoidably linked with consumerism. When corporate monopolies are removed, free enterprises in a competitor-rich environment must rely on a distinctive edge other than simple price differentiation. Individual pharmacies must then fight for the satisfaction and loyalty of patients (aka consumers) or die. As a result, business-wise entrepreneurs emerge and thrive by offering better and newer services/goods (i.e. quality care, medication review, disease specialization, compounding, injection services, etc) and enrich the environment and practice. Eventually, these become standard practices until the next great innovation perpetuating the cycle of innovation and enterprise.     


4. Pharmacy ‘store-in-stores’ erodes pharmaceutical care and commodotizes the pharmacy


Pharmacies located within grocery stores, department stores, etc. relegate the service to merely another aisle or service counter in the store, allowing the service to decrease at the pharmacy without being acted on by the consumer. Because of the added convienience of shopping while a perscription is filled the lack of service may be overlooked as an opportunity cost of the convienence. As this happens, a decrease in care creaps into society and overall negatively affects both patient care and the profession.


What is personalized medicine? Should pharmacists be involved, and what should they be doing?What is personalized medicine?

Personalized medicine differs from the modern medicine that we know of in that it is completely tailored to every individual patient. The medicine that is practiced today in hospitals and other care facilities revolves around treatment decision made based upon guidelines, and studies, all of which look at the impact on a representative group of our population. The fact is, everyone is different! This raises the question: can every person be treated the same way with the same results? No. Every person is different and everyones response to different treatments and medication is different. This is why the concept of personalized medicine was developed. Imagine having your genome sequenced so that we are able to predict which diseases you are at risk for. Also, it would be possible to determine which enzymes are more prevalent in your body, allowing us to determine the perfect dose of medication to use.

Should Pharmacists be involved?

Of course pharmacists should be involved. While doctors spend their time determining diseases patients are at risk for, or what type of a certain disease a patient has, pharmacists can work on the best way to treat that patient based on their “personalized” information.

What should they be doing?

Pharmacists can play a role in determining the exact dosing of medications depending on a person’s CYP enzymes for example. By doing so, they will eliminate almost all adverse effects, allowing for better patient compliance and better efficacy.


by: group 22.

Written by Kevin

February 2nd, 2012 at 1:06 pm

What is personalized medicine? Should pharmacists be involved, and what should they be doing?

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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,  

Written by PHAR 330 2012 Group 6

February 1st, 2012 at 11:31 pm

Personalized Medicine – Students’ Perspectives

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Although personalized medicine holds the promise of revolutionary safer, more effective treatments, one must also consider possible pitfalls of tailoring designer drugs for certain segments of the population. The information afforded to clinicians through personalized medicine would be invaluable; identifying the best possible medication for an individual without a trial and error process will undoubtedly save both time and money for patients and our health care system as a whole. But what will drug companies do with this information? Big pharma is notorious for guiding drug development by profits (e.g. me too drugs), rather than continuously producing new, innovative drugs that could truly help patients. One would hope that the birth of personalized medicine, would be accompanied by equal advancements in drugs for the population as a whole. However, based on their track record, it would not be unreasonable to fear that drug companies will base their research on the most lucrative segments of the population, while neglecting those whose genetic makeup makes it harder to find an ideal treatment. Furthermore, coverage could begin to be determined based on what medications should work for patients. Patients who have been stable on a medication for an extended period of time could have their coverage cut if our interpretation of their genes suggests that it is not a cost-effective choice for them. These factors could create “underprivileged” phenotypes who have less new medications to choose from, or less coverage for drugs that are already available.
Despite the many positive opportunities for patients, there are potential pitfalls to the implementation personalized medicine as well. Pharmacists, with their expertise in pharmacogenomics, are in an excellent position to invigilate this process and to ensure that patients have equal access to optimal therapies regardless of their genetics. – KC

Meals can be custom-made at restaurants because the customer may have allergies or is a vegetarian. Now think about extending that concept into designing a medication therapy specifically for one patient. The idea of personalized medicine revolves around the heightened ability to tailor a treatment option according to the patients’ genes. The ideal outcome is being able to catch potential adverse drug reactions before administration of the medication and ultimately increase the overall effectiveness of the drug therapy. However, as personalized medicine is slowly being developed, there still remains various factors that may hinder the process of bringing the concept to general practice.

By genotyping a patient’s DNA, trained pharmacists with the help of lab technicians are able to examine the appropriateness of certain medications even before giving it to the patient. This would help greatly reduce the need for trial and error, thereby minimizing the risk of side effects and shorten the time required to correct ineffective treatment. The fundamental principle of personalized medicine appears to be promising, but the drawbacks and barriers should also be carefully considered.

When looking at the practicality of personalized medicine in the community, the chances of having a variant allele or mutation in a single gene in a pool of wild type individuals are quite rare. Consequently, the usefulness of this concept of tailoring medications may not be of great interest to pharmaceutical companies who look toward making drugs that are safe and effective for a larger population. Furthermore, the process involved in decoding a patient’s genotype and then analyzing possible mutations and variants is a time-consuming process for pharmacists and lab technicians alike. This would then come down to how these professionals should manage their time from other duties, as well as the method of reinbursement for their work.

Personalized medicine is a prospective beginning to taking advantage of new understandings of the human genome and cutting-edge technology in science. However, it is essential to look at the practicality of the concept and how it can extend its use to benefit not just a small group of patients. Pharmacists being the central expert in medication use, can serve as one of the leaders in developing this new area of patient-orientated care. —Ying (Joane) Tang

Orphaned illnesses can sometimes be neglected in pharmacogenetic research, where funds are often doled to find cures for illnesses affecting large populations. The ethics of this matter comes down to “quantity of treatment outcomes” rather than improving the quality of life of select individuals, as research companies try to maximize the number of people who can benefit from treatment. Some rare genetic, fatal illnesses afflict only a few in a million, and these patients are unfortunately unrepresented in the research sector where pooling billions and billions of dollars for a potential miracle cure that would only benefit a select number of individuals would be unlikely. These patients find comfort instead in online chat rooms where another patient from halfway across the world might happen to share the same genetic point mutation as them, and through collective blogging, derive meaning through their chronic illness experience.

This points to the idea of striking a balance between social support and biomedical treatment. The term “personalized medicine” conveys a sense of comfort  and emotional support for patients, but for patients who know nothing about the molecular workings of DNA and gene-directed therapy, or what we can call the “scientific connotation” of personalization, this term might only be illusory. Educating the public about what personalized medicine really is, through an introduction to the basics of DNA and genetics, would dispel these myths for patients who may otherwise feel deceived or disappointed about the treatment they actually receive. At the same time, social support for rare genetic illnesses that remain unrepresented in research for a cure would be greatly appreciated. As pharmacists, we can certainly seek a balance between the two connotations of “personalized medicine” – the knowledge behind its technology, and the empathy we exude in caring for our patients. -GC

Ethical issues regarding personalized medicine.
Personalized medicine has many limitations and challenges regarding policy (ie. how to implement new technologies) and science problems (technical problems). Although it’s probably going to be a challenge to come up with an optimal solution that satisfies many people, I think that these can be resolved by proposing a solution and considering the appropriateness and reasoning. But ethical issues are very tricky in nature in that there’s a dilemma and both sides have pros and cons for justification.
1. Protection of patient privacy is going to be the most important and challenging thing that must be done for individualized medicine. Everybody agrees that patients have the right to keep their health information from other people but how far does that right extend? For example, personalized medicine facility may have collected information regarding what diseases one has (or at risk of having those diseases) based on one’s genotype and gene expression. How do we keep that information private and how do we determine the extent of applying that knowledge to medical procedures such as diagnosis and profiling? Is it okay for that individual to have automatic access to all his genetic information once it has been decoded? What about privacy from other family members? Once one learns of his/her genetic risk of a disease, he/she may infer relative’s risks. Is that fine?
2. Cost issues are also a significant ethical issue in the world of personalized medicine. Many people do not have health insurances (in the case of US) or they have insurances that only cover the basic things. How do we provide access to personalized medicine to everybody? It’s probably unlikely for personalized care to be equally accessible to everybody due to this problem. Provision of this type of care will likely to be stratified similar to US’s traditional medical care and universal access is denied. In that case, is it right that due to cost issues, some people have more comprehensive information about their genetic make-up, while others have limited amount of information they can get access to? – TK

Written by klc16

February 1st, 2012 at 9:16 pm

Pharmacists and Personalized Medicine

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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 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. (

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: Accessed [date of access].

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

Written by stephhsieh

February 1st, 2012 at 5:43 pm

Posted in Personalized Medicine,Pharmacy

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Pharmacists and their role in personalized medicine.

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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.



Group 12

Written by toreylau

February 1st, 2012 at 5:11 pm

Posted in Personalized Medicine,Pharmacy

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Pharmacy’s Role in Personalized Medicine

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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

Written by anthonle

February 1st, 2012 at 12:40 am

Pharmacists have no place in a dispensary.

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Pharmacists have no place in a dispensary. Period.


History of the Profession:

In the past, pharmacists were masters of their domain, they would prepare compounds from scratch, double check their own work, and frequently owned their own businesses.  Like many other industries however, in recent decades the profession has changed.  As new diseases are discovered,  old diseases are better understood, the number of drugs available to treat these have steadily increased.  With this increased understanding, and increased availability of drugs, the number of individuals with regular or recurring prescription drugs has drastically increased.  This has demanded increases in efficiency and scale of dispensaries in communities.  This is not uncommon, the streamlining of professions like pharmacy is akin to the implementation of machines in factories to increase productivity.  It only stands to reason then, that as the sheer volume of prescriptions that are written increases, the community pharmacy industry will find ways to improve efficiencies.


What Pharmacists do (Currently):

As it currently stands, community pharmacists have 3 main roles in pharmacy. The first is assessing the appropriateness of therapy for an individual, this cognitive work is unique to our profession, and because of our specialization in training, we are, bar none, the most proficient profession at doing this. Secondly, is counselling the patient on the medication, this is also a unique skill that only pharmacists can perform, as we receive more training and education on doing this than any other profession. Thirdly, is we physically check prescriptions, ensuring that from point of entry, to point of sale, the drug that was prescribed is in the correct bottle, and goes to the correct patient.  This portion of our job can be done by anyone who can read a doctor’s writing, and who has enough visual acuity to compare tablets in a stock bottle to those in the dispensed bottle.  Pharmacists are no better trained to do this than any technician.  Depending on the pharmacy, the third role of pharmacists can easily take up the majority of the pharmacists time, with the time dedicated to assessing therapy and counselling being severely limited.  Consider the following: the vast majority of community pharmacies are owned by large corporations, with the minority being privately owned stores.  The current business model for community pharmacies is based on the volume of prescriptions dispensed, and not the quality of care.  Additionally, most of these large companies are publicly traded companies, which forces huge emphasis on them to cut costs and maximize profits wherever possible.


The problem:

Community pharmacy in general is trending towards a business model wherein they can accomplish selling the most number of prescriptions, at the least cost to themselves.  As I already stated, the third role of the pharmacist (technical role) occupies the majority of the pharmacists time in most community pharmacies; and this role is easily replaceable.  What we have already begun to see is the training of technicians who will perform the coveted task of “final check” on prescriptions.  Simply put, this job is to ensure that correct product is in the correct bottle for the correct patient.  Herein lays the problem.  Large corporations have the right idea.  There is no reason that pharmacists should be performing this role; we are no more proficient checking prescriptions than a technician, and yet we hold monopoly on it, and expect 2x-5x the salary for it.  Who can blame these large companies for lobbying to have this power relinquished by pharmacists? From a business standpoint, they can eliminate more than 50% of the pharmacist’s workload in the community pharmacy, by replacing them by equally capable, and much cheaper, technicians.


The flaw of current practice model:

So what does this mean for pharmacists?  It means that the fundamental model of community practice is going to change.  The problem is that pharmacists exist in a bizarre loophole of how they are financially renumerated.  The vast majority of pharmacists in community are in one of two situations. They either work for a pharmacy (private or corporate) or own their own pharmacy.  Either situation is faced with the same dilemma.  On one hand, the pharmacy in which a pharmacist may work is reimbursed by the volume of prescriptions sold, which are paid for by the government via pharmacare.  On the other hand, the pharmacists themselves are paid salary by the pharmacy they work for.  Therefore, for pharmacists to protest against the implementation of registered technicians, they are going against their employers best interests.

What this results in is two bodies lobbying the college of pharmacists for conflicting changes to the territory of physically checking prescriptions.  The pharmacists want to protect their monopoly in this area, and the companies who own the pharmacies want to employ skilled technicians to do it for cheaper. The result is a profession which is at war with itself.  When pharmacists are involved in selling prescriptions, they are inescapably stuck in a tug-of-war between good business vs good healthcare.


What is the solution?

Get pharmacists out of the dispensary.

As I already stated, the majority of the pharmacists work currently is performing the “final check” on prescriptions.  Pharmacist should not be doing this for 3 main reasons:

1) Technicians can do the exact same job for cheaper (like it or not).

2) Being responsible for the “final check” ties pharmacists inexorably to the current business model which requires high volume of prescription sales. This generates the conflict of interest between pharmacists and the employers.

3) This is not what they are trained for, and is an inefficient use of pharmacists as a resource.  In current practice the two roles we are actually trained for: Therapy assessment and Counselling, are SECONDARY to checking prescriptions.  Pharmacists are the experts at counselling, and therapy assessment, NOT physically checking prescriptions.  Perhaps more importantly however, is the fact that because of current business models, these important skills  of pharmacists are woefully underutilized.  Were pharmacists able to provide adequate therapy assessment and counselling to every patient, the adherence to medications, quality of life, and savings to healthcare system would be extraordinary.

How do we accomplish this?

It is a simple as passing legislation which mandates that “before any prescription can be filled, it must be signed by both a physician (prescriber) AND pharmacist (assessed proper therapy)”.  One such model of this would place the pharmacist in the medical clinic, right across the hall from the physician.  For instance:  A patient comes in, sees the physician, gets diagnosed with a strep throat, the doctor writes a prescription for antibiotics, and the patient leaves, walks across the hall to the pharmacist. The pharmacists takes the prescription, assesses the appropriateness of it, evaluates the patients other medications, and then counsels the patient on the antibiotics right then and there.  After counselling, the pharmacist signs off on the prescription, which the patient can take to any dispensary, and have filled. At this point the prescription has been assessed for appropriateness and the patient has been counselled.  The patient goes to a pharmacy, and the technicians which work there count the correct number of tablets from the correct bottle, perform a final check, and dispense it to the correct patient.

With this model, pharmacists are now able to perform the job they are trained to do, and because they are situated in the same geographic location as the prescribing physician, they are much more apt to communicate as a team, resulting in better healthcare.

There are many different possible models of payment for pharmacists with this model.

  • The first options is that pharmacists could have a billing account like physicians do, and be renumerated different amounts depending on task which they performed.  Assessing new therapy can be billed at X, whereas doing an entire medication review could be billed at Y… etc..
  • Alternatively, the pharmacist could be paid a salary, much like nurses and other staff in a medical clinic are.  For instance, the physician has a billing number which he bills for all patients that he sees.  Out of the money he is renumerated, he pays the wages of any associated staff at the clinic.  Pharmacists could be paid in the same manner that nurses at the clinic would be; hourly or monthly etc.  This may require adjustments to the amounts that physicians can bill for, but these are small details in the grand scheme of things.

The net result is that the government will be paying pharmacist’s wages instead of community pharmacies.  This removes any conflict of interest between pharmacists providing thorough care to patients, and the rush to sell as many prescriptions as possible.
How would we finance this?


Change the dispensing fee on prescriptions from $10 per prescription, to $1.  Dispensaries are no longer providing the cognitive services that used to be fulfilled by pharmacists, so this professional fee no longer applies.  This makes dispensaries much more like any business which sells goods, where the profit is due to mark-up on the drug costs.

This means that all the money that the government would have paid for dispensing fees, is now available to fund pharmacists.  The same amount of money that the government had set aside for cognitive service before will now be available to pay pharmacists! The only difference is that now, without the burden of the technical work they previously were buried under…. pharmacists will be able to provide much more time, and much better care to each and every patient.


A functional model of practice for pharmacists:

What would happen:

  1. Pharmacists move out of dispensaries.
  2. Legislation passed requiring prescriptions to be signed off by both a Physician and Pharmacist before getting filled at a dispensary.
  3. Pharmacies (dispensaries) no longer need pharmacists, and only employ technicians.
  4. The professional fee on each dispensed prescription is drastically reduced, and the money is reallocated to paying pharmacists directly (in their medical clinic setting).

Who this is good for:

  1. The patient.  Pharmacists will have SUBSTANTIALLY more time to counsel patients, develop a therapeutic relationship, and assess their current therapy completely, on a much more regular basis. Results in better medication adherence, decreased risk of complications from diseases, and improved quality of life.
  2. The taxpayers/government.  The amount of money available to pay pharmacists after cutting the amount of professional fee currently reimbursed will pay for pharmacists salaries, so the net cost is the same.  In addition, by providing much better care, the pharmacists will be able to reduce the number of hospital admissions every year, and prevent many medication related complications with any patient’s health, resulting in substantial savings.
  3. The community pharmacies.  These businesses will no longer have to employ pharmacists.  They can save substantial amounts of money by employing completely capable technicians to do the entire technical role of dispensing a prescription.  Whether or not these savings are balanced with the loss of revenue due to not receiving dispensing fees however, remains to be seen.


In summary:

As a pharmacy student, I am in an impossible situation.  I am less than halfway through training for a profession which is in very dire straights.  If it doesn’t extricate itself from its current entanglement with business, it will die.  This will be a huge loss to the healthcare system, patients, and the pharmacists.  Currently, many practicing pharmacists are either too complacent, or too busy trying to stay afloat with the onslaught of prescription volume they see at work, to address this overarching problem.  As a student, I hardly have the time to think of solutions for our profession’s problem.  However, the frightening reality is; that unless we make these changes, and soon, the profession might very well go down a path from which there is no return.


Jordan S, Pavan M, Erik M, Jonathan C, Justin T, Jieun K,  Maggie C



Written by jstew26

January 31st, 2012 at 11:47 pm

Personalized Medicine and Pharmacist Involvement

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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

Written by shaylee

January 31st, 2012 at 10:36 pm

Posted in Personalized Medicine,Pharmacy

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