PHARMACOGENOMICS
can change over time. More specifically, the genetic profile of cancer can even change during treatment.
Because of these intricacies and nuances in the field, expectations about pharmacogenomics need to be managed – both within the professional community and in discourse with end users. In a recent report into the ethics of pharmacogenetics, the Nuffield Council on Bioethics Report touched on the risk of over-promising when it said that genomics might not be about finding the “right drug for the right person,” but instead suggesting a potential drug preference for genetically defined groups.
Ethical challenges
There are several other ethical challenges that might arise from widespread introduction of genomics. One pressing issue is the risk that significant price variations will begin to creep into drug company product development around certain categories of medication. Let’s suppose, for example, that a company has an expertise in hypertension drugs. Genomics information may enable it to segment potential customers based on their genetic profile. For smaller sub-groups, they may decide there is no point developing a tailored hypertension drug, preferring to focus on easy-to-treat patients. Even if they do develop drugs for smaller segments of the hypertension market, it may come at a higher price. This, in turn, creates the
population, but work in a smaller sub-group. Or it could make it possible for pharma companies to market drugs that have not been released or have had restricted distribution because of contraindications in a small segment of the user-based. The issue of a two-tier system doesn’t simply relate to spending power within a country, but also questions around ethnicity.6 One recent development in this regard has been the NitroMed’s launch of BiDiL for the treatment of heart failure in African- Americans. While some have called BiDiL the first “ethnic drug,” it has also sparked a debate about whether the use of race or ethnicity in genomics opens up the possibility of genetic discrimination. In a similar vein, care also needs to be taken to ensure genomics-based treatment doesn’t simply become a luxury for patients in advanced economies. This point was raised in a 2011 paper7
– though encouragingly
unwelcome possibility of a two-tier healthcare system emerging. There are, however, counterarguments to this scenario. Proponents of pharmacogenomics point out that pharmaceutical companies will be able to bring new drugs to market more quickly, since genomics will enable them to dispense with large-scale trial-and-error testing. Likewise, genomics could help revive drugs that are ineffective in the general patient
the authors concluded that advancements in the field of pharmacogenomics would benefit developing economies if certain designated strategies were put in place.
Data usage and privacy
As we have seen in the last year, there are also a myriad of issues related to data usage and privacy. In the context of genomics, for example, questions arise over who controls the data – private firms or public organisations.8
Further issues arise regarding who might get to see the data, including
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