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PJ Online homeThe Pharmaceutical Journal
Vol 275 No 7363 p226
20 August 2005

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· MDSs (4)
· Regulation
· Pharmacy practice (2)
· Hospital disinfection
· Controlled drugs
· Pharmacogenomics
· Registration examination (2)
· Retention fees (4)

Letters to the Editor


Creating a new dimension to pharmacy practice

From Dr P. F. Long

It is now over 50 years since Watson and Crick described the structure of DNA, postulating a copying mechanism that provides a chemical basis for genetic transmission and a scientific basis for Mendelian inheritance of traits. In these intervening 50 years or so, we have gone from sequencing relatively short sequences of DNA to having the enabling technologies to sequence entire genomes, culminating in 2001 with completion of the human genome project.

Deciphering the human genome has led to an explosion in genetic tools to diagnose, manage and treat diseases. What is still poorly understood is how the genes controlling our growth and development from conception to birth and on through to adulthood might also interact with gene networks that influence our response to particular medicines — this is the science of pharmacogenomics. Being able to predict atypical drug responses will allow the dose of medicines to be individually tailored and adapted to avoid toxicity and maximise clinical efficacy.

Pharmacogenomics offers pharmacists an innovative opportunity to create a new dimension to their practice by accessing genetic services, expanding current primary delivery in health care promotion and patient management. Easy-to-use gene chip technology opens up the possibility of risk assessment even in community-based settings to screen individuals with poor metabolising phenotypes, developing personalised treatment plans so that the right patient receives that right drug at the right time.

It is already possible at a reasonable cost to test quickly for polymorphisms in cytochrome p450 genes, which encode for enzymes that play a major role in the way an individual metabolises drugs. The ability to distinguish between fast and slow metabolisers would allow prescription and dispensing of appropriate drug doses and the monitoring of an individual’s response to treatment simultaneously.

Genotype profiling could become an integral part of a person’s medical records. Although this information offers the potential to design appropriate prevention and intervention priorities, pharmacists must consider and become knowledgeable about their attendant ethical, legal and social responsibilities in handling genetic information.

The scope and standards delineating the roles and responsibilities of pharmacists in providing genetic health care have yet to be defined by the Royal Electronicjuice, but supporting patients and families, partnering them to meaningful health decisions and becoming fluent in the management of genetic health information are just a few of the emerging roles pharmacogenomics could make a reality for tomorrow’s pharmacy graduates.

Paul Long
Lecturer in Pharmaceutical Microbiology
School of Pharmacy
University of London

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