Feature Pharmacogenetics

Fitting the drug to the patient

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39133.452315.AD (Published 01 March 2007) Cite this as: BMJ 2007;334:452
  1. Susan Mayor, freelance journalist
  1. London
  1. susan{at}mayor.dircon.co.uk

    Designer drugs with minimal side effects were meant to revolutionise prescribing. Susan Mayor investigates why the reality may be less dramatic

    Hitting the genetic profile button on his computer, David White, a general practitioner in a busy practice in Leicester, gets a list of the antihypertensive drugs and doses most suited to the 60 year old patient sitting in front of him. He gives the computer generated prescription to the patient and asks him to see the practice nurse in a couple of weeks for a follow-up visit. This is what Francis Collins, leader of the Human Genome Project and director of the US National Human Genome Research Institute, predicted doctors would be doing in the next few years.

    In 2001, he wrote: “Genetic prediction of individual risks of disease and responsiveness to drugs will reach the medical mainstream in the next decade or so. The development of designer drugs, based on a genomic approach to targeting molecular pathways that are disrupted in disease, will follow soon after.”1

    This prediction now looks a bit overoptimistic. “Biology is much more complex,” comments Klaus Lindpaintner, head of the Research Center for Medical Genetics with Roche. “But the idea of pharmacogenetics is certainly playing an increasingly important role in the way we think about developing drugs.”

    What is pharmacogenetics?

    Pharmacogenetics analyses genetic differences between individuals in their response to medicines. These can include variations in drug metabolism due to genetic differences in liver enzymes, idiosyncratic adverse reactions due to specific predisposing genetic features, and genetic predictors of response. Professor Lindpaintner explains the attraction: “This approach promised more bang for the buck for patients and providers, with the greater likelihood of a response and reduced risk of side effects.”

    Health service providers are keen to explore genetic approaches to optimising use of drugs. The UK genetics …

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