By Kirell Lakhman

Pharmacogenetic testing could be a "potential positive contribution" to health care in the US, so long as clinicians and pharmacists receive more training in the discipline, according to the current issue of the journal Research in Social and Administrative Pharmacy.

Participants in the small study — it followed just 35 individuals — "desired a high level of information and effective communication from their health-care professionals," which means that "PGx education of clinicians and pharmacists will be essential to satisfy consumers' requirements," the paper said.

Hoping to "explore the views of the general public regarding their current use of medications, and their experiences of side effects and opinions on PGx," the study authors used a questionnaire and focus groups "to determine participants' experiences with medication use and opinions on PGx," according to the paper.

The results of the focus group discussions showed "a common theme" surrounding the "desire to have a holistic approach to disease diagnosis and medication selection," the study says.

Participants also "raised concerns" about the "current level of side effects experienced with medications" and about the "storage and privacy of genetic information and the costs involved." The study authors defined these concerns as "potential barriers" to implementation of PGx testing.

To be sure, the study has one modest flaw: each of its 35 subjects "suffered a chronic medical condition and/or had an immediate family member with a chronic medical condition." Such individuals tend to be more involved in their health care, and regularly sniff around the Internet and elsewhere for information about new tests or treatments that could improve their quality of life. A follow-up trial, if one is planned, should include healthy controls.

The study also adds to the wilting mound of papers bemoaning the paucity of pharmacogenetic training offered to new physicians, who are inculcated to be cautious and conservative. This isn't to say ordering pharmacogenetic tests is cavalier. Rather, MDs on the whole simply don't know enough about the stuff to act on it. And this isn't news.

As the RSAP paper notes, pharmacogenetic testing is "rarely used in clinical practice" today, and "thus far there have been few studies investigating consumers' perceptions of the barriers to the implementation of PGx in clinical practice."

These knowledge chasms have forced the American Medical Association this summer to adopt a new policy to "support" personalized medicine as a way to improve patient care, and the HHS Secretary's Advisory Committee on Genetics, Health, and Society around that time recommended that the federal government convene a workshop to "identify innovative education and training approaches to integrate genetics and genomics into clinical care."

The RSAP study also adds a nice touch by mentioning pharmacists in particular, whose role in the health-care continuum has been reduced in recent decades to mere middlemen.

Sure, a PharmD or RPh will occasionally ask if a customer bearing a new script has any medical allergies or is susceptible to any drug interactions. But these questions are far from universal, and are miles from the kinds of pharmacogenetic goals the medical community has set for itself.

At least some of the bigger drug-dispensers have seen the cost-savings potential of PGx testing and are beginning to take steps to exploit it — with one program in particular that has the potential to hurt some labs.

If left to molder, these challenges — training MDs and PharmDs about PGx — will leave clinical labs holding the short end of the stick because it would limit the number of PGx tests that are ordered.

Physicians should be exploiting whatever genetic and pharmacogenetic testing options are available to them, however few of them there are at the moment, and pharmacists ought to be acting less like middlemen and more like information brokers.

As one recent study points out, pharmacists, "as drug therapy experts, are in a unique position to push the frontiers of pharmacogenetics in both the research and clinical practice environments." As another concludes, "pharmacists should be ready to implement pharmacogenetic management.”

Clinical labs should be right behind them, pushing and prodding.

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