Personalized Medicine and The Pharmacist

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