By Kirell Lakhman
Drug makers and pharmacogenomics researchers have reason to be anxious that physicians entering practice today will be ill-equipped to embrace personalized medicine.
Pharmacogenomics has become “part of the language” to which medical school students are exposed, according to Stephen Huot, associate professor of medicine at Yale University, but it has yet to make it into the core curriculum of any but a few of the US’s 126 accredited medical schools.
The medical school of the University of Vermont — where deputy NHGRI director Alan Guttmacher once served as director for genetics — has retooled its curriculum and now offers a genetics track through all four years of its MD program. But UVM is a rare exception.
To be sure, it is not that no one in medical schools is knowledgeable of pharmacogenomics. Instead, Huot notes, the problem is that those with the cutting-edge experience — researchers — don’t necessarily have direct contact with students. “What students tend to learn is what a medical school has identified as a core curriculum, and those things are the personal interests of the people who are lecturing in the classrooms,” he explains.
Huot predicts that physicians will get their pharmacogenomics education from diagnostic labs. “I don’t think we’re going to be teaching people what the DNA [sequences] are … but I think we will be teaching them, as the information evolves, how to use laboratory data that show different responses to different classes of medication,” he says.
Professional medical societies could also play a role in educating physicians about personalized medicine. The American Academy of Family Physicians believes that pharmacogenomics will play a big role in primary care and family practice and plans to direct an annual “clinical focus” on genomics in 2004, according to Norman Kahn, vice president of science and education at the AAFP.
The group has also helped launch a program to teach genetics and genomics to a variety of medical-school faculty. Co-funded by the AAFP, the NHGRI, and the US Health Resources and Services Administration, among others, the program, Genetics in Primary Care, has organized 20 national “teams” to bring genomics curricula to faculty teaching family medicine.
“The idea is to prepare faculty in primary care to incorporate the genetic revolution into the teaching of medical students and residents,” Kahn says.
Gary Peltz, a physician and head of genetics and genomics at Roche Palo Alto, whose company is one of the largest supporters of pharmacogenomics technologies, says that as more drug makers begin using pharmacogenomics tools, “it is essential that the health-care providers understand and are comfortable with these technologies.” Schools that do not offer concrete pharmacogenomics-related curricula create “the first gap in what has to happen to bring [pharmacogenomics] to students,” Peltz says.
Peltz knows this issue firsthand. As a faculty member at UCSF, he has been turned down four years in a row on a proposal to install genetics as part of a medical boards review course at the school. Why? Because genetics — never mind pharmacogenomics — is still outside the mainstream among faculty decision makers, Peltz says.
Huot, who was asked to make introductory remarks at a recent pharmacogenomics symposium sponsored by Yale’s department of internal medicine and paid for by Genaissance Pharmaceuticals, is slightly more optimistic. Students who attend medical school in a community in which genomics or pharmacogenomics technology is being developed, such as Boston, San Diego, and San Francisco, will be first to be exposed. “In these kinds of places, students will see posters for seminars. They’re going to get notices in their e-mail,” Huot says.
“If it’s viewed that it really matters in terms of decision-making as a doctor, and it’s intellectually exciting, then people will do what they need to do to become aware of it. Things that really matter are the things that people go and learn.”