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Can Indiana University Med School Make Its Students PGx-Literate?

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At A Glance

Name: David Flockhart

Title: Professor medicine, genetics, and pharmacology

Background: Chief of the Division of Pharmacology at Georgetown University

Education: MD, University of Miami; PhD, Welsh National School of Medicine, Wales, UK; BS, University of Bristol, UK

Age: 51

 

It’s no secret that one of the biggest challenges facing pharmacogenomics today is ensuring that medical students learn as much as possible about the discipline before they begin practicing medicine. Trouble is, few medical schools have adjusted their curricula to ensure their students are pharmacogenomics-literate, according to many industry insiders.

However, some schools have taken steps to educate their students about genotyping, sequencing, and gene-expression technologies and applications [see 5/9/03 PGx Reporter]. The University of Vermont has a well-respected genetics department, while the University of California system has perhaps one of the most comprehensive pharmacogenomics programs [see 11/13/03 PGx Reporter].

Now, Indiana University’s School of Medicine, the second-largest med school in the United States, is entering the fray. In November, David Flockhart, a professor medicine, genetics, and pharmacology, applied for a National Institutes of Health grant as a supplement to a 5-year program that began at the school in December 1999. This grant, which sought to develop a pharmacogenetics core lab for the General Clinical Research Center at Indiana University School of Medicine, was an extension of a program that Flockhart had begun at Georgetown University while he was chief of the medical school’s division of pharmacology.

Pharmacogenomics Reporter caught up with Flockhart last week.

What is the goal of this grant?

To stimulate pharmacogenetics research across the campus at the Indiana University School of Medicine, and also at the university in general. Also, we wanted to provide a resource that would be available nationally to other General Clinical Research Centers. The idea was that this GCRC would be able to serve as a resource for the other two GCRCs [at the University of Pittsburgh, run by Marjorie Romkes, and at Washington University, overseen by Howard McLeod], as well as [become] particular stimuli for pharmacogenetics research within their own campuses.

How many faculty and departments participate under this program at Indiana?

Here, there are five divisions and three departments involved. The three departments are psychiatry, medicine, and pediatrics. Within medicine, there are five divisions. These include the cancer center, clinical pharmacology, gastroenterology, cardiology, and infectious disease.

The goals of pharmacogenomics programs at other schools would be to integrate the research within these departments and divisions in order to get the faculty and students thinking in the same way about pharmacogenomics. Is this true of Indiana’s pharmacogenomics programs?

The idea is to get everybody from medical students on up aware of the field; to provide some teaching, but also to provide basically a core lab that is able to do assays. It is also to have a service at a relatively cut rate for researchers so they can get into the field quickly. It also aims at providing pharmacogenetics-interpretation expertise within the core.

It’s one thing to have the ability to test for genetic variants in relevant genes; it’s much more important to have available people who can interpret those changes, and who can help design studies in a logical way.

People in the industry have said time and again that students from a majority of medical schools worldwide will be pharmacogenomics-illiterate when they graduate. What’s your take?

That’s really true; they haven’t even heard of it. … I think arguably the most important thing in the growth of pharmacogenetics is [its ability to] help a lot of patients is the education of providers, physicians, clinicians, and nurse practitioners. And so we’re really trying to do this in an organized way — not only by training providers, but also ... training people that can counsel patients on pharmacogenomics. It’s … important to have good ways of educating physicians in such a way that the treatment options that are made available by pharmacogenetics are optimally applied.

I can’t tell you how important I think that is. I think if there is one vulnerability of pharmacogenetics as a field, it’s that we might make some ethical mistake that would damage the field in the same kind of way that gene therapy has been damaged.

Indiana is home to some pretty big pharmaceutical companies, such as Roche and Lilly. Does your school provide a way for academia and industry to collaborate?

The core lab has an educational [component] attached to it that is aimed at improving pharmacogenetics within the schools. There are people from both companies [Lilly and Roche] that participate in the teaching programs. But the companies would not use the core lab themselves.

What can a student or faculty at Indiana expect to find in the core lab?

It has … molecular biology equipment, and the means to perform high-throughput genetic testing for variants in candidate genes. We have people who are experts at searching the human genome using publicly available web sites. These people are also able to use proprietary databases to identify genetic variants in candidate genes that we’re interested in.

They can also help researchers identify candidate genes attached to clinical problems that they are interested in. It’s a two-step process:

A researcher comes to us and wants to know whether there is a genetic component as a side-effect of this drug that he’s been studying. So he would sit down with a scientist in the core lab, and they would construct a pathway for the drug … identify candidate genes along that pathway, and then go and search the genome to see if there are variants in the genome at a frequency that sounds doable.

I have to say that the level of teaching about clinical therapeutics — about how to use drugs well — is very limited. It is a national problem. We have very sophisticated means of doing diagnostic teaching — teaching people how to use MRIs, CT scans, and so forth.

But our ability really as a medical education system to provide teaching about clinical therapeutics has lagged way, way, way behind. And so we’re trying to insert pharmacogenetics into a structure that at the moment is pretty weak.

 

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