Pharmacogenetics: Ethical Issues

Books reviewed:
Pharmacogenetics: Ethical Issues , Report by the Nuffield Council on Bioethics. London: Nuffield Council on Bioethics. 2003. xxiv + 103pp. £10 to all European countries (including postage); £15 to non-European countries (including postage); £0 to developing countries. Available free of charge at: http://www.nuffieldbioethics.org/filelibrary/pdf/pharmacogenetics_report     

Saliva Ontology: An ontology-based framework for a Salivaomics Knowledge Base

Background  

The Salivaomics Knowledge Base (SKB) is designed to serve as a computational infrastructure that can permit global exploration and utilization of data and information relevant to salivaomics. SKB is created by aligning (1) the saliva biomarker discovery and validation resources at UCLA with (2) the ontology resources developed by the OBO (Open Biomedical Ontologies) Foundry, including a new Saliva Ontology (SALO).     

Pharmacogenetics: the bioethical problem of DNA investment banking

Concern about the ethics of clinical drug trials research on patients and healthy volunteers has been the subject of significant ethical analysis and policy development--protocols are reviewed by Research Ethics Committees and subjects are protected by informed consent procedures. More recently attention has begun to be focused on DNA banking for clinical and pharmacogenetics research. It is, however, surprising how little attention has been paid to the commercial nature of such research, or the unique issues that present when subjects are asked to consent to the storage of biological samples. Our contention is that in the context of pharmacogenetic add-on studies to clinical drug trials, the doctrine of informed consent fails to cover the broader range of social and ethical issues. Applying a sociological perspective, we foreground issues of patient/subject participation or 'work', the ambiguity of research subject altruism, and the divided loyalties facing many physicians conducting clinical research. By demonstrating the complexity of patient and physician involvement in clinical drug trials, we argue for more comprehensive ethical review and oversight that moves beyond reliance on informed consent to incorporate understandings of the social, political and cultural elements that underpin the diversity of ethical issues arising in the research context.     

Pharmacogenetics of cancer chemotherapy

Significant heterogeneity in the efficacy and toxicity of chemotherapeutic agents is observed within cancer populations. Pharmacogenetics (PGx) is the study of inheritance in interindividual variation in drug disposition. The allure of pharmacogenetics, in the treatment of cancer patients, comes from the potential for individualisation of cancer therapy, minimizing toxicity, while maximizing efficacy. In this review we will focus on the current and potential clinical applications of pharmacogenetics in cancer therapy by citing relevant examples and discussing the possible approaches which may be used to establish a reliable, reproducible and cost-effective test for clinically relevant genetic polymorphisms, using easily accessible biological samples (e.g., blood and tumour samples). Ideally, routine management of patients would include analysis of their single nucleotide polymorphism linkage disequilibrium (SNP-LD) profile prior to treatment, allowing stratification of patients into treatment groups, thus individualising their therapy. In order to achieve this ambition, a combination of different approaches (candidate gene, genome-wide and pathway driven) will be required from scientists and clinician scientists, as well as an increased understanding and incorporation of pharmacogenetic aims and endpoints into current and future clinical trials.     

Pharmacogenetics of community-acquired pneumonia

The rate of acetylation of xenobiotics affects the course and prognosis of infectious diseases. The efficacy of antibiotic therapy of community-acquired pneumonia in RA-patients is lower than that in LA-ones. In order to ensure the best antimicrobial effect on the onset of the disease it is required to use regimens with the maximum permissible dose of antibacterial drugs in the regions where the rapid type prevails.     

Pharmacogenetics in drug development

Over the last two decades, identification of polymorphisms that influence human diseases has begun to have an impact on the provision of medical care. The promise of genetics lies in its ability to provide insights into an individual's susceptibility to disease, the likely nature of the disease and the most appropriate therapy. For much of its history, pharmacogenetics (PGx-the use of genetic information to impact drug choice) has been limited to comparatively simple phenotypes such as plasma drug levels. Progress in genetics technologies has broadened the scope of PGx efficacy and safety studies that can be implemented, impacting on a broad spectrum of drug discovery and development activities. Recent PGx data show the ability of this approach to generate information that can be applied to dose selection, efficacy determination and safety issues. This in turn will lead to significant opportunities to affect both the approach to clinical development and the probability of success--the latter being an important aspect for pharmaceutical companies and for the patients who will benefit from these new medicines.     

Richard Weinshilboum: Pharmacogenetics: The future is here!

Richard Weinshilboum has a no-nonsense attitude about pharmacogenetics. He is enthusiastic about the practicalities and ramifications of the field's solid accomplishments, but he carefully measures statements that might feed the hype that is en courant about the brave new postgenomic world of drug therapy. Although the terms "pharmacogenomics" and "pharmacogenetics" are often used interchangeably (a linguistic quirk to which Weinshilboum does not object), he consistently avoids the latter, perhaps more glitzy, word. Weinshilboum has spent over thirty years as a clinical pharmacologist, exploring in particular the variability of drug metabolism that occurs among patients as a function of their genetic constitution. The research efforts from his line of work have materialized into clinical application and have helped to set the stage for the individualization of drug treatment according to each patient's genetic constitution-not yet on the genomewide scale that Weinshilboum enthusiastically foresees, but certainly as pertains to multiple genes and drugs for any given patient. The interview with Weinshilboum occurred at this year's annual meeting of ASPET, at which he was conferred the Harry Gold Award in Clinical Pharmacology.