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The Pharmaceutical Journal
Vol 269 No 7226 p770
30 November 2002

Pharmacists' views on pharmacogenetics sought

Pharmacists, along with other health care professionals and the public, have been asked for their views on ethical issues raised by the development of pharmacogenetics.

In a consultation document published last week, the Nuffield Council on Bioethics points out that genetic analysis to predict response to medicines is now theoretically feasible. However, it adds that there are a number of constraints to this personalised approach to health care. One point raised is that genetic tests will not reveal whether a patient is a responder or non-responder to a particular medicine. "Rather, tests will reveal the likelihood of responding to treatment." The council asks whether or not a patient who only has 30 per cent likelihood of responding to a particular treatment should receive it through the public health care system."

Other questions raised include: for individual therapy, should tests be available directly to patients over the counter or on the internet, or should they only be available through medical practitioners as part of a decision about the use of a prescribed medicine?

"As regards clinical practice, general practitioners, pharmacists and patients themselves will all be implicated," the report says. It adds that patients may be concerned about having a pharmacogenetic test and asks whether such patients will be able to refuse testing if one relevant to their treatment is available. The council also points out that genetic information derived from large groups of patients is likely to be shared by health care providers, including pharmacists. It asks: "What level of anonymity should be accorded to genetic information and what kinds of consent should be required for the collection of samples?"

The council recently set up a working party to consider the ethics of pharmacogenetics and intends to publish a report in the autumn of 2003. The consultation document is available on the internet. The deadline for responses is 19 February 2003.

Pharmacists need to know about developments

Pharmacists need to be aware of what is developing in the field of pharmacogenetics because they will be seeing more applications in practice within the next three years, Dr Edward Campion, assistant professor of medicine at Harvard Medical School, Cambridge, Massachusetts, told The Journal. He was speaking during a recent conference on pharmacogenetics at the Pasteur Institute in Paris.

"We are now at the interface between research and clinical practice and pharmacists will be the ones who are expected to know how gene patterns can be used to improve response to drugs and reduce toxicities," said Dr Campion. However, despite recent rapid advances, Dr Campion does not think that in the forseeable future, everybody will have their genetic profile on a microchip. Rather, genetics will be used to provide specific answers. For example, it will provide clinicians with an extra diagnostic test where gene patterns can indicate whether or not a tumour will require aggressive treatment. It may also be able to give information about people's susceptibility to diseases.

Dr Campion, who is also senior deputy editor of The New England Journal of Medicine, said that the NEJM is currently publishing a series of articles on genetics and that these will be available, free, online at www.nejm.org.