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Attitudes of Health Care Professionals Toward Pharmacogenetic Testing

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Abstract

Background: Pharmacogenetics has emerged as a new tool for the optimization of drug therapy. Although the pharmacogenetics concept was first recognized at least 50 years ago, clinical testing to determine pharmacogenetic traits is still relatively rare, and many hurdles are markedly slowing its development. There is a lot of literature and speculation about potential ethical challenges in genetic and pharmacogenetic testing, yet few researchers have actually examined the attitudes of health care professionals regarding the clinical application of these tests.

Objective: In this article, we aim to review the current literature on health care professionals’ perceptions of the role of pharmacogenetic data and describe the attitudes of medical students when faced with a clinical pharmacogenetic testing scenario.

Methods: A group of 59 third-year medical students from the American University of Beirut Medical Center were asked to answer a questionnaire about pharmacogenetic testing after being exposed to a clinical scenario of a patient who was diagnosed with mild Alzheimer Disease (AD) and hence was a candidate for therapy with one of the acetylcholinesterase (AChE) inhibitors.

Results: The students indicated that they would respect patients’ confidentiality and inform them about the test results and therapeutic plan, but they would not be as open about bad prognoses. They did not agree on the therapeutic plan that would follow a pharmacogenetic test result and were uncertain about potential patient discrimination in insurability.

Conclusion: Our and others’ findings demonstrate the existence and seriousness of several challenges pertaining to pharmacogenetic applications in the clinical setting. Further training and education are needed for health care professionals, since they are the ones who will most probably request these tests in the near future.

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Acknowledgments

No sources of funding were used to conduct this study or prepare this manuscript.

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Authors and Affiliations

  1. Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon

    Nathalie K. Zgheib &  Ramzi Sabra

  2. Salim-El Hoss Bioethics & Professionalism Program, Faculty of Medicine, American University of Beirut, Beirut, Lebanon

    Thalia Arawi

  3. Department of Pathology and Laboratory Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon

    Rami A. Mahfouz

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  1. Nathalie K. Zgheib
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  2. Thalia Arawi
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Correspondence to Ramzi Sabra.

Appendix 1

Appendix 1

Clinical Scenario Provided to Third-Year Medical Students at the American University of Beirut Medical Center

“You recently diagnosed a 60 year old previously known healthy gentleman, to have mild Alzheimer Disease (AD), and you are considering starting therapy with one of the acetylcholinesterase (AChE) Inhibitors. You know that there is a gene called APOE involved in the regulation of cholesterol levels in the body. Three versions (alleles) of the gene have been identified: ɛ2, ɛ3 and ɛ4, with APOE ɛ4 being associated with an increased risk of early onset of AD and a decreased or no response to AChE inhibitors (in one trial, 60% of the APOE ɛ4 homozygous AD cases did not change or even got worse after 30 weeks of therapy). Luckily, testing for APOE genetic polymorphisms is readily available in your institution. It is apparently commonly requested by cardiologists because the APOE ɛ4 version is also a risk factor for atherosclerosis, premature coronary artery disease and peripheral vascular disease.”

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Zgheib, N.K., Arawi, T., Mahfouz, R.A. et al. Attitudes of Health Care Professionals Toward Pharmacogenetic Testing. Mol Diag Ther 15, 115–122 (2011). https://doi.org/10.1007/BF03256401

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