By: Nathan Seligson, Class of 2015

Pharmacists have a unique perspective on medication therapies. Commonly referred to as “drug experts”, no other health professional has a deeper, more encompassing understanding of pharmaceuticals. Much like the clinical study of pharmacokinetics, pharmacogenomics is destined to be implemented by qualified pharmacists¹.

Pharmacogenomics concerns itself with the effect of genetic differences on the transport, metabolism, and dynamic physiological interactions between our bodies and medications². These areas of medical science have been mainstays of the pharmaceutical profession. While other healthcare professionals may have the capability of understanding the complex science of pharmacogenomics, the burden of implementation is most appropriate for a profession that has years of training in pharmacokinetics and pharmacodynamics.

A false assumption concerning pharmacogenomics is that the implementation of this clinical science will solely involve laboratory work followed by a computerized algorithm whose output is a precise clinical decision for an individual patient. No equation can account for every variable that goes into a clinical decision, and therefore a well-trained clinician must be involved with the individualization of therapy for every patient. This is the same for pharmacogenomics as it is for other clinical sciences.  Pharmacogenomics can provide us with valuable information about how a patient will react to a medication; however raw genomic data is useless without being interpreted by a highly trained individual with a comprehensive understanding of the complexities of pharmacology and genomics.

Clinical pharmacogenomics is a natural fit for implementation by pharmacists. Pharmacists have proven their utility as clinicians³. In clinical drug therapy support, medication therapy management, and the individualization of drug therapy using pharmacometrics, the addition of a pharmacist into the role of a clinical decision maker has drastically improved patient outcomes^4,5.

Citations:

1. de Denus S, Letarte N, Hurlimann T, Lambert JP, Lavoie A, Robb L, Sheehan NL, Turgeon J, Vadnais B. An evaluation of pharmacists’ expectations towards pharmacogenomics. Pharmacogenomics. 2013 Jan;14(2):165-75.
2. Sim SC, Kacevska M, Ingelman-Sundberg M. Pharmacogenomics of drug-metabolizing enzymes: a recent update on clinical implications and endogenous effects. Pharmacogenomics J. 2013 Feb;13(1):1-11.
3. Wallerstedt SM, Bladh L, Ramsberg J. A cost-effectiveness analysis of an in-hospital clinical pharmacist service. BMJ Open. 2012 Jan 5;2:e000329.
4. Yu J, Shah BM, Ip EJ, Chan J. A Markov model of the cost-effectiveness of pharmacist care for diabetes in prevention of cardiovascular diseases: evidence from Kaiser Permanente Northern California. J Manag Care Pharm. 2013 Mar;19(2):102-14.
5. Seden K, Bradley M, Miller AR, Beadsworth MB, Khoo SH. The clinical utility of HIV outpatient pharmacist prescreening to reduce medication error and assess adherence. Int J STD AIDS. 2013 Apr 5.

Works consulted

1. Reiss SM; American Pharmacists Association. Integrating pharmacogenomics into pharmacy practice via medication therapy management. J Am Pharm Assoc (2003). 2011 Nov-Dec;51(6):e64-74.
2. Crews KR, Cross SJ, McCormick JN, Baker DK, Molinelli AR, Mullins R, Relling MV, Hoffman JM. Development and implementation of a pharmacist-managed clinicalpharmacogenetics service. Am J Health Syst Pharm. 2011 Jan 15;68(2):143-50.