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UK Pharmacist Society Tries to Move Pharmacogenomics Into Mainstream

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A handful of staffers at the Royal Pharmaceutical Society of Great Britain are devising a plan to build a three-way pharmacogenetics bridge between drug and diagnostic makers, pharmacists, and physicians.

The mission of the association’s working party on pharmacogenetics, now almost two months old, may become a boon for pharmacogenomics tool providers, molecular diagnostics shops, and biopharmas by showing British prescribers that the discipline is very much alive.

The group might also help Britain’s National Health Service — historically underfunded and overburdened — to save money by nipping in the bud potentially wasteful prescribing habits.

“We recognized that personalized medicine … and the use of pharmacogenetic information to improve the safety and efficacy of medicines, is one of the pharmacist’s roles,” said Tony Moffat, chief scientist at the RPS. “What we … want to find out is what it is we can do to assist pharmacists … to derive the greatest benefit from the technologies that are available today.”

Although the RPS’ overture is at least the second of its kind among similar national organizations — the Washington, DC-based American Pharmacists Association drafted a pharmacogenetics policy in 2000 [read APhA’s draft here] — the British program is unique because it attempts to place pharmacists at the forefront of patient care. In the United States, for example, pharmacists have long been relegated as mere dispensers of prescription medications, and have had relatively little direct influence in individual treatment protocols.

In Britain, however, the nature of the national health-care system manages to bypass this logistical hurdle even though it struggles with two stark problems: chronic wait lists and endemic rationing. The RPS believes pharmacogenomics can help obviate both problems — the NHS can save money if patients are treated more effectively, the theory goes.

Additionally, British physicians “tend to be conservative in their prescribing habits,” said Richard Ley, a spokesman for the Association of the British Pharmaceutical Industry. “That’s a feature we’d like to change.” The RPS initiative may engender this change.

Moffat said he is cautiously optimistic about the technology, and said it will help give British pharmacists a larger role in patient care. The technology “is still not in an exactly usable form, but it’s just getting there. And I think what we would like to do is to make sure that everybody knows where the knowledge is, how to use the knowledge, and what research needs to be done.”

There are around 45,000 pharmacists in the UK, each one of whom is required to be a member of the RPS in order to practice. These days, although the RPS is “interacting” with the NHS’ Department of Public Health to obtain research funds, the pharmacogenetics group supports itself on a £5,000 ($8,000) annual budget, according to Moffat. That money flows to the program from the annual membership fees each pharmacist pays.

“We feel it is sufficiently important that we are willing to open our wallets,” said Moffat. “The working party very much relies on our members and other people who are interested in this to come along and spend their own time … to undertake work for us in drawing up papers, et cetera.” The brunt of the group’s funds, he said, helps pay for paperwork and travel expenses.

The three-person group, whose platform is still evolving, is also trying to determine what its own expectations should be, what education established pharmacists might need in the future, and what kind of pharmacogenetics education pharmacists-in-training should receive.

Though the details still need to gel, Moffat stressed that the RPS pharmacogenetics initiative will thrive if there is adequate partnering. Pharmacists in the UK “will interact with clinical pharmacologists, general practitioners, and industry so that we all work together for the benefit of the patient.” (The pharmacogenetics program is currently consulting with pharmaceutical and biotechnology companies, including AstraZeneca and Lilly, said Moffat.)

To help flesh out its raison d’être, the group over the past three years has organized pharmacogenetics sessions at the RPS’ annual conference, and the meetings have been reported in the association’s weekly publication, The Pharmaceutical Journal. Hypothetically, the pharmacogenetics program aims at helping British pharmacists apply pharmacogenetics like this: If a patient presents with, say, a myocardial infarction secondary to hypertension, the pharmacist will seek to partner with the patient’s physician to help devise the best diagnostic and therapeutic strategy.

“If there are pharmacokinetic tests available that would aid the prescribing,” said Moffat, “then clearly they should be carried out.” Yet “the trouble” is that many molecular diagnostic tests are not easily available in the UK, Moffat said. So “part of the push we’re having is with the British In Vitro Diagnostics Association, to get these tests into the market as soon as possible.”

The pharmacist’s role under an expanded pharmacogenetics initiative, Moffat stressed, “would be exactly the same.” However, pharmacists would flag cases in which pharmacogenetic testing might be a wise accoutrement, or even precursor, to a therapeutic option. The pharmacist would be able to suggest to a physician that a diagnostic test should be ordered, and that same pharmacist can order, or even perform, the test himself, Moffat said.

“We want to scope out the relevance of pharmacogenomics to pharmacy, and we as pharmacists can improve patient care and the supply of medicine by doing that,” he said. “We need to first scope out what we need to do, then split up into subgroups and tackle each one of these things individually — ‘What clinical research needs to be done, what kinds of direct interaction should the group have with the NHS, what ethical standards should be set?’” He said, for example, that the Royal College of General Practitioners will be “intimately involved in this area. So let’s talk to them now.”

When asked whether the working group can expect any resistance from physicians, Moffat said turf battles are unlikely because, in the end, both groups are paid by the same people.

“We broached that problem a long time ago,” he said. “The patient is the central focus here. And the doctor or surgeon [will] have to be in charge of that person’s medical care.

“Consequently, pharmacists are a part of that team, and people regard other members of that team not exactly of equal standing, but having relevant standing. Their advice is listened to. We don’t have an ‘us-and-them’ situation,” he said.

“I suppose the bottom line is that we’re pretty grown up over here,” said Moffat. “But also, the NHS pays everybody’s salaries.”

— KL

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