Why Are Pharmacogenomics Not Fully Implemented in Health Care?

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A look at how the genetics-based research field can become more fully integrated in all areas of health care going forward.

Everyone in health care wants to improve the safety of patients and raise the overall quality of care in their respective fields. How, specifically, that is done, is where big questions—both clinical and ethical—start to arise.

Marylyn D. Ritchie, PhD, MS, BS, led a session1 at AHSP Summer Meetings in Baltimore, Maryland,in which she discussed the role of pharmacogenomics in health care, how they can improve patient safety, and why they aren’t being used more commonly in the field.

Pharmacogenomics aren’t a novel idea—the phrase has been used since 1959. The overarching goal of pharmacogenomics is to help us understand how genetics can affect an individual’s response to medications. Ideally, Ritchie says, we will reach a point in health care where providers can find something in the genome of an individual and accurately predict how that person is going to react to a certain medication, and what exactly in their genetic makeup caused them to react that way.“ [We should] implement genetic testing in the trials, so we give the right medication to the right sub-populations,” Ritchie said.

And while the idea is not particularly hard to grasp, the implementation was—and continues to be—met with some pushback. “I have a lot of colleagues affiliated with pharmacy, and for years they were very resistant to pharmacogenomics, because what you want is a medication that will be a blockbuster drug and hit as much of the market as possible,” Ritchie said. “So, the idea of tailoring treatments and having treatments only work for small subgroups of the population isn’t really the model we want for drug design.”

But, Ritchie continued, that might be exactly why the pharmacy world should welcome pharmacogenomics with open arms. Because when drugs are made to appeal to everyone, they often hit a testing roadblock by causing adverse effects within those small subgroups, which causes the drugs to neversee the light of day.

“Thousands of drugs never make it through clinical trials,” she said. And, according to Ritchie, many of those adverse effects experienced within those subgroups are due to underlying genetics; a problem that, in theory, pharmacogenomics could mitigate.

But pharmacogenomics come with a unique set of problems, one of those being the complexity of genome testing. Pharmacogenomics aren’t simply one test that an individual takes that will let them know which medications are safe, and which could be potentially dangerous due to their genetic makeup. Instead, pharmacogenomicsare a series of tests for every person, meaning the scale of full implementation would be a massive undertaking, both financially and with regard to time commitment.

From a patient perspective, inappropriate use of genetic information could be a fear that individuals have. DNA data has made headlines multiple times in the past few years, most notably when the United States Government demanded the site Ancestry hand over DNA information about users on the site, which they declined to do.2

In the end, Ritchie says a greater implementation of pharmacogenomics into all medical practices is necessary, and potentially lifesaving.“We need to teach every specialty about pharmacogenomics.”

References
1. Ritchie M PhD, MS, BS. Pharmacogenomics: Improving Quality and Safety of Healthcare. Presented at: American Society of Health-System Pharmacists Summer Meetings and Exhibition; June 10-14, 2023; Baltimore, MD.
2. Ancestry Fights The US Government As Feds Try To Grab DNA Data. Forbes. February 4, 2020. https://www.forbes.com/sites/thomasbrewster/2020/02/04/ancestry-fights-the-us-government-as-feds-try-to-grab-dna-data/?sh=3b1b7b035871


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