As medicine targets
personal DNA profiles, researchers examine ethics and patient experiences
August 05, 2004
Researchers
at the University of York are beginning a major study into the ethical and
personal issues raised by a potential revolution in healthcare, which could
incorporate individualised medical care – pharmacogenetics - into clinical
practice.
The use of genetic testing as a routine part of medical treatment opens
exciting horizons, but brings with it the responsibility to understand the
concerns individuals may have about DNA sampling, and about wider issues
such as the possible impact of genetic information. Much of the science of
pharmacogenetics is known, but there are many potential hurdles to overcome
before the technology is introduced into routine medical use.
Over the next three years Professor Andrew Webster, Dr Graham Lewis and a
team in the Science and Technology Studies Unit (SATSU) at York will work
with colleagues across the UK monitoring patients’ reactions to warfarin,
commonly used to prevent blood clots. The team from York will interview some
of the 2,400 patients who will be selected for the study. Of the 2,400
patients, 2000 will be hospital-based and 400 will be recruited through GP
surgeries as warfarin can be prescribed by GPs.
Patients’
responses will be mapped against their personal DNA profiles and the SATSU
team will interview them to see how they feel about DNA samples being taken,
and how publicly acceptable this would be, and the hurdles to introducing
the technique.
Warfarin is a very useful drug currently taken by 600,000 patients in the
UK, but a small proportion of those who take it suffer serious side effects,
even sometimes death. If a patient’s genetic makeup is known beforehand,
doctors can prescribe far more accurately so that there are fewer serious
side effects.
But the serious ethical issues to be considered, such as reading individual
genetic codes from DNA samples, affect both patients and the clinical staff
who will have to introduce the new and complex technologies. Clinical staff
experiences of these processes are also examined through interviews. Dr
Lewis commented; “it is important to study how attitudes and perceptions
change with the introduction of new medical technologies like
pharmacogenetics, and that means studying the experiences of doctors and
nursing staff as well as patients.”
Dr Lewis added: “It’s been known for a long time that an individual’s
genetic make-up affects the way they respond to medicines, both in terms of
the likelihood of adverse side effects, and whether they respond to
treatment. Pharmacogenetics, or so-called personalised medicine, offers the
exciting possibility of individualised treatment.
This could revolutionise medical care, giving doctors the ability to
prescribe the best drug for their patient without trial and error.
But there are major considerations – confidentiality, the impact of the
genetic information on the patient, and the implications for their families.
We need to understand how people will view this new development.
"There are also cost implications – is it worthwhile introducing
pharmacogenetics? There is no real evidence yet from large-scale trials. We
need to recognise that many other factors such as diet, lifestyle and age
affect a patient’s response to warfarin treatment.”
The genetic profiling of patients taking part in the study will not
influence their own treatment but will hopefully help future warfarin users.
The teams involved in the study will share £840,000 in research funding from
the Department of Health.