Teaching clinical pharmacology.
In the current information age, with an explosion of drug-related data, the prime topic for discussion is how to teach clinical pharmacology. New drugs, often with new indications, are emerging more rapidly. The patients being treated are older and sicker than previously, and are taking more drugs. Patients' expectations about safety and efficacy, and the information they will receive about drug treatment are rising. Adverse events and litigation related to the use of drugs is increasing. There is a widening gap between the demand for new drugs and the resources available to pay for them. In this environment there is a pressing need for medical graduates to be fully prepared to take on the responsiblilities of prescribing and to be able to respond to the rapid changes in therapeutics that will be inevitable in the coming years.
The number of pharmacogenetic tests in clinical use is likely to increase considerably over the next decade. At present most testing is provided by specialist clinicians in oncology, HIV medicine and by physicians using immunomodulators. Future pharmacogenetic tests are likely to be relevant to primary care physicians and potentially available at the point of care. It is vital that all doctors are aware of the potential and impact of this technology and that they have the knowledge base to implement it in the clinical care of their patients. We must provide a core competency in pharmacogenetics, which must be encouraged and supported and allowed to develop to mirror its increased clinical application.
Research in pharmacogenetics is currently developing in two main directions: firstly, identifying specific genes and gene products associated with various diseases, which may act as targets for new drugs, and, secondly, identifying genes and allelic variants of genes that affect our response to current drugs.
- Establishment of prescribing guidelines, based on clinical studies, for drugs that are subject to substantial polymorphic metabolism.
- Prescribing advice will relate dose to genotype and will highlight the possibility of drug interactions when multiple drugs are prescribed concomitantly.
- Establishment and recording of individual patient genotypes that is, "personal pharmacogenetic profiles".
- Pharmacogenetic testing will substantially reduce the need for hospitalisation, and its associated costs, because of adverse drug reactions.
- Development of new drugs for patients with specific genotypes that is, "drug stratification"