The importance of including topics related to pharmacogenetics, pharmacogenomics, and medical genetics in the pharmacy curriculum.

To the Editor. The literature contains a body of evidence documenting variations in drug response among individuals. This includes differences in the extent of adverse drug reactions as well as efficacy of the drug therapy. In addition to physiological and environmental factors, genetic makeup has a profound impact on an individual's response to drugs. This has given rise to the field of personalized molecular medicine, which uses genetic information along with other biomarkers to predict an individual's response to drugs and determine the accurate dosage of several drugs based on the individual's genotype. Pharmacists are experts in pharmacotherapy who provide pharmaceutical care to patients. Over the past several years, the scope of pharmacy practice has evolved to meet the requirements of the patient-centered care environment. In addition to dispensing prescriptions, pharmacists also are involved in patient-care actions, such as making decisions related to the pharmacotherapy of patients, counseling patients on their diseases, treatments, and medications, as well as promoting health. Pharmacogenomics is an emerging field that impacts many, if not all, of these aspects of the pharmacy practice. Knowledge of pharmacogenomic principles will prepare pharmacists to interact more effectively with other health care practitioners to further optimize pharmacotherapy for patients based on their specific genotype. Increasing evidence in the literature clearly shows that variations exist as a result of polymorphic expression of genes involved in metabolizing enzymes, transporters, and drug targets. The clinical application of such knowledge can consequently reduce the risk of side effects and improve the efficacy of the drugs. Virtually all disciplines within the pharmacy curriculum will be affected to some degree by basic understanding of drug response through pharmacogenomics and pharmacogenetics.1 The view that pharmacists can be trained for new roles as experts in pharmacogenomics is widely discussed.2,3 The American Council on Pharmacy Education has asserted that “The College or School's professional degree program curriculum must prepare graduates with the professional competencies to enter pharmacy practice in any setting to ensure optimal medication therapy outcomes and patient safety, satisfy the educational requirements for licensure as a pharmacist, and meet the requirements of the university for the degree.”4 This requires pharmacy schools to provide sound training in pharmacogenomics to prepare pharmacy students to fulfill their numerous responsibilities as first-line health care practitioners. According to a report published in 2005, however, 40% of pharmacy schools surveyed did not provide any pharmacogenomic instruction in their curriculum.5 In another report, pharmacogenomics was not taught in over 20% of 41 responding US pharmacy schools.6 Many schools did not implement topics related to the genetic basis of disease, and the ethical, social, and economic implications, as has been recommended by the American Associations of Colleges of Pharmacy Academic Affairs Committee. Among 85 accredited pharmacy schools, only 5 had basic genetics as a course requirement for entering pharmacy school or as a part of the pharmacy curriculum7. During the 2008 American Association of Pharmaceutical Scientists (AAPS) annual meeting, academic members of the pharmacogenomics (PGx) focus group expressed concern over the lack of pharmacogenomic education in pharmacy schools.5, 6 PGx members agreed that pharmacogenomics should be taught in pharmacy schools to provide future pharmacists with a thorough understanding of the genetic component of patient variability in drug response. Furthermore, they suggested that a basic genetics course should be considered a prerequisite for this course, which would provide a solid foundation for pharmacogenomic concepts. When developing a pharmacogenomics course, the following topics should be covered: principles of genetics, the human genome project, genetic variability, inheritance, genetic basis of the human diseases, pharmacogenetics of drug absorption, distribution and elimination, biopharmacy, pharmacogenetics and clinical pharmacokinetics, genetic differences in pharmacodynamics, drug targets and transporters, polymorphic genes of clinical significance, pharmacogenomics and the future of therapy, cost effectiveness and quality of life, and ethics and medical implication of genetic testing. Additional case studies may be used to highlight the current application of PGx information in cancer, cardiovascular, psychiatry, infectious disease, organ transplantation, hematology and the drug discovery process. Sam Harirforoosh, PharmD, PhDa Lawrence Fleckenstein, PharmDb Pramod Mahajan, PhDc Okezie I. Aruoma, PhD, DScd Ying Huang, MD, PhDe Majid Moridani, PharmD, PhDf,g aBill Gatton College of Pharmacy, East Tennessee State University bCollege of Pharmacy, University of Iowa cCollege of Pharmacy and Health Sciences, Drake University dTouro College of Pharmacy eCollege of Pharmacy, Western University of Health Sciences fSchool of Pharmacy, Texas Tech University Health Sciences Center gSchool of Medicine, Texas Tech University Health Sciences Center