Last week saw the launch of a public consultation on the ethics of pharmacogenetics - the use of genetic tests to decide on the safest and most effective medicines for an individual. In years to come, such tailored treatments may be a routine part of healthcare, with your doctor checking out your DNA before writing out any prescriptions. But there are practical and ethical issues associated with this approach, which the Nuffield Council on Bioethics raises in its paper, well before such technology becomes a reality.
The consultation paper asks whether pharmacogenetic tests may lead to inequalities in healthcare, giving rise to a situation where only medicines that are suitable for a majority of the population are widely available. There are also ethical issues surrounding the storage of test results, especially if a genetic variation associated with a drug response is later shown to be involved in a disease. The document also points out potential benefits of pharmacogenetics. For example, useful drugs withdrawn because of side effects in a small minority of people might be reinstated, once they can be prescribed safely.
At the moment, the process of deciding which medicines might be most effective for a particular person is largely one of trial and error. This has its drawbacks, as different people can react to the same medicine in different ways - for example, one in ten people gets no pain relief from the drug codeine. Some of these differences are likely to be genetic, so pharmacogenetic tests could be one of the first ways in which information from the Human Genome Project has a practical effect on our lives.
Pharmaceutical companies in the business claim that the mantra for future healthcare will be 'the right medicine, for the right patient, at the right dose'. But as the consultation paper points out, the reality could be that pharmacogenetic tests provide doctors with probable, rather than definite answers. For example, they might reveal that a patient has a 55 per cent chance of responding well to a particular drug, with a two per cent chance of side effects. If this is the case, it may prove more cost-effective to continue with a 'suck it and see' approach to prescribing medicines.
The technology behind personalised prescriptions is still in its infancy, and may never be able to provide doctors with definitive answers. However, there are many practical, social and ethical issues that need to be addressed before pharmacogenetics has the potential to become an integral part of modern medicine. The launch of last week's public consultation is a timely and welcome start to this debate.
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