Advancing pharmacogenomics in pharmacy practice
SPM: Cover Story
Dream big and invent the future you want to be a part of!
On September 16, at the APhA Industry Partners Meeting in Washington, DC, I told colleagues that I believed we would see 3D printing in the future capable of producing medications customized to an individual’s genome at the point of care. My assertion was, in part, based upon recent news that a functioning carbon fiber automobile had recently been produced by a 3D printer. Little did I know that proof of concept for the first step of reproducing an existing medication would come so soon! On October 25, Medical News Today reported that the University of Central Lancashire produced a new 3D printer that can “print” a tablet with a precise quantity of medicine suitable for administration to patients.
To take this idea a few steps further, imagine what might be possible if components could be added to those “printed medications” to provide live, real-time monitoring. It isn’t so far-fetched considering University of California San Diego scientists have recently presented Nanoscale 3D printing and tissue engineering applications, and researchers from Switzerland have produced wireless remote monitoring of glucose levels using nanostructures and biosensors.
On December 1, a Technology Review report, “3-D-Printing Bio-Electronic Parts,” indicated that researchers were able to print light emitting diodes for the first time with new “inks” that contain semiconductors. It is not improbable that there will soon be molecular machines capable of transmitting signals for effective patient monitoring.
After dreaming about what might be possible and making sure there is evidence to support it, review the context and history that provides a basis for how it could all fit together.
How to get there
Key forces defining professional practice include an aging population, continuing increases in new prescription medications and volume, expansion in community pharmacy, movement of prescription products to OTC status, pharmacoinformatics, pharmacogenomics, nanotechnology, molecular machines, and a broad scope of practice. Pharmacists are the medication use experts in health care today and have an important role to play in that process which includes the following five key components: prescribing, dispensing, administering, monitoring, and systems management. Customizing and tailoring care for patients in a way that empowers them, improves outcomes, enhances safety, and reduces total costs for care is what is sought.
I believe that the best way to get there is to put patients first, properly align incentives, optimize medication use, increase effective communication, and securely exchange health care information. Improving population health is an essential part of our professional role; it is a fundamental core of what pharmacists do. How it gets done varies depending on your chosen practice and setting. It may be focused on certain conditions, therapeutic categories, medications, prevention, or treatment. While the focal vector for care delivery may vary, it should be done in a way that produces high quality, holistic care for every patient.
Will pharmacy be ready?
In February 2011, the APhA Foundation, in collaboration with the Coriell Institute for Medical Research, held the first training session for a dozen pharmacists to participate in the recently founded Council of Applied Pharmacogenomics. The intent of the session was to put pharmacists on the health care team to provide patients with pharmacogenomics-related coaching services from medication-related pharmacogenomic reports in the Coriell Personalized Medicine Collaborative (CPMC) initiative. While the ideas were significantly ahead of the demand for this type of service and the number of actionable drug–gene pairs have not been identified as quickly as predicted, the ground-breaking work of the CPMC continues to evolve and will one day, I believe, present practical opportunities for broad application in pharmacy practice. Will the profession be ready for it when that day arrives? I think we are moving in the right direction.
In November 2012, the APhA Foundation convened a group of interdisciplinary stakeholders to be part of the Committee to Advance Pharmacogenomics in Pharmacy Practice. The committee discussed the role of pharmacists in personalized medicine, gathered information, and outlined a strategic plan to advance pharmacists’ patient care services in pharmacogenomics. That planning blueprint was created to help guide collective efforts of patients, payers, policymakers, pharmacists, and other providers to advance pharmacist–provided pharmacogenomics services. It includes the following five key areas of focus: research and evidence; practice or business models, standards, and policies; education; health information technology; awareness and advocacy.
In December 2013, a Genome Medicine article, “The Coriell personalized medicine collaborative pharmacogenomics appraisal, evidence scoring and interpretation system,” described a rigorous systematic effort designed to translate published clinical and scientific pharmacogenomics data into standardized diagnostic tests with clear therapeutic recommendations. Part of this effort includes the CPMC Pharmacogenomics Advisory Group, an expert advisory panel of pharmacists, geneticists, a bioethicist, pharmacologists, and clinicians that provides guidance on pharmacogenomic risk reporting. The Pharmacogenomics Appraisal, Evidence Scoring and Interpretation System has now identified and approved seven commonly prescribed drugs for pharmacogenomic reporting to CPMC participants. These identified drug-gene pairs include: clopidogrel and CYP2C19; warfarin and CYP2C9/VKORC1/CYP4F2; proton pump inhibitors and CYP2C19; codeine and CYP2D6; thiopurines and TPMT; simvastatin and SLCO1B1; and celecoxib and CYP2C9.
Implementation of pharmacogenomics in clinical care is about to shift into a new gear and offers significant promise that can lead to improvements in medication use. I believe that staying current in this evolving discipline will be a cornerstone of professional success for pharmacists in the future. You can obtain a wealth of information from the Genetics/Genomics Competency Center (G2C2) at www.g-2-c-2.org. There are more than 50 free resources specifically identified for pharmacists at http://g-2-c-2.org/discipline/pharmacist.
In a recent article on www.genome.gov, Jean Jenkins, RN, PhD, summed it up very well: “As the health care professional focused on medication use, pharmacists are uniquely positioned to be the leader on the health care team for pharmacogenomics. The new resources on G2C2 provide pharmacists one convenient place to access a variety of resources on the topic,” wrote Jenkins.
Whatever path you choose, do the right thing for the patient and the rest of it will fall into place. If you can dream it, you can invent a preferred future!