Personalized Medicine and The Pharmacist

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Future of Pharmacy Practice

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In order to promote policy change, we need to educate the public about how an expanded pharmacist role can ultimately reduce health care spending while improving patient outcomes. This is no simple task as many people feel their pharmacy is just a place they shop at but with that said, pharmacists are the #1 most trusted professional as voted by Canadians. Let’s take advantage of this trust.
Specialization is one means by which pharmacists can justify the cause for an expanded scope of practice. The role of Pharmacogenomics and tailoring drug therapy to the individual patient will  improve patient health, reduce the physician workload, expand and utilize the knowledge of pharmacists who are trained but do not perform such tasks in the current structure of the healthcare system and reduce unsustainable health care spending.
Tied with this is  public outreach and advocacy. A joint initiative rather than a competition between health care professionals is what is needed. By working together and establishing ways to improve each practitioner’s role within health care, we can prevent animosity and improve patient care. We must prove benefits to each practitioner that would be affected by an increase in pharmacist scope. If we can do this, it will be a positive step in securing our careers and satisfaction as health care professionals moving forward.

Written by aaron

February 2nd, 2012 at 11:42 am

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Do you think pharmacists should be doing personalized medicine?

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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

Written by ksltai

February 1st, 2012 at 9:04 pm

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Personalized Medicine – the newest iteration of an ongoing trend in medicine

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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)

Written by rseipp

February 1st, 2012 at 5:50 pm

Posted in Personalized Medicine

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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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Topic 1

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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

Written by melissa123

January 30th, 2012 at 3:05 pm

Posted in Personalized Medicine

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