We use cookies to improve your experience. By continuing to browse this site, you accept our cookie policy.×
Skip main navigation
Aging Health
Bioelectronics in Medicine
Biomarkers in Medicine
Breast Cancer Management
CNS Oncology
Colorectal Cancer
Concussion
Epigenomics
Future Cardiology
Future Medicine AI
Future Microbiology
Future Neurology
Future Oncology
Future Rare Diseases
Future Virology
Hepatic Oncology
HIV Therapy
Immunotherapy
International Journal of Endocrine Oncology
International Journal of Hematologic Oncology
Journal of 3D Printing in Medicine
Lung Cancer Management
Melanoma Management
Nanomedicine
Neurodegenerative Disease Management
Pain Management
Pediatric Health
Personalized Medicine
Pharmacogenomics
Regenerative Medicine

Addressing ethical challenges at the intersection of pharmacogenomics and primary care using deliberative consultations

    Cristina Longo

    Department of Family Medicine, McGill University, Montreal, QC, Canada

    ,
    Vasiliki Rahimzadeh

    Department of Family Medicine, McGill University, Montreal, QC, Canada

    ,
    Kieran O'Doherty

    Department of Psychology, University of Guelph, Guelph, ON, Canada

    &
    Gillian Bartlett

    *Author for correspondence:

    E-mail Address: gillian.bartlett@mcgill.ca

    Department of Family Medicine, McGill University, Montreal, QC, Canada

    Published Online:https://doi.org/10.2217/pgs-2016-0092

    Aim: Primary care physicians will play a central role in the successful implementation of pharmacogenomics (PGx); however, important challenges remain. We explored the perspectives of stakeholders on key challenges of the PGx translation process in primary care using deliberative consultations. Methods: Primary care physicians, patients and policy-makers attended deliberations, where they discussed four ethical questions raised by PGx research and implementation in the primary care context. Results: Stakeholders voiced skepticism regarding PGx funding, commercialization, regulation, maintenance of an equal access healthcare system and restructuring of health research incentives and priorities in the public sector. Conclusion: Deliberants developed governing principles for a PGx-specific charter of ethics, aiming to protect the interests of patients, and outlined recommendations for the future of PGx in primary care.

    Papers of special note have been highlighted as: •• of considerable interest

    References

    • 1 Harper A, Topol E. Pharmacogenomics in clinical practice and drug development. Nat. Biotechnol. 30(11), 1117–1124 (2012).
    • 2 Bartlett G, Antoun J, Zgheib NK. Theranostics in primary care: pharmacogenomics tests and beyond. Expert Rev. Mol. Diagn. 12(8), 841–855 (2012).
    • 3 Grice GR, Seaton TL, Woodland AM, Mcleod HL. Defining the opportunity for pharmacogenetic intervention in primary care. Pharmacogenomics 7(1), 61–65 (2006).
    • 4 Soumerai SB, Mclaughlin TJ, Avorn J. Improving drug prescribing in primary care: a critical analysis of the experimental literature. Milbank Q. 83(4), doi:10.1111/j.1468-0009.2005.00435.x (2005).
    • 5 De Bakker DH, Coffie DS, Heerdink ER, Van Dijk L, Groenewegen PP. Determinants of the range of drugs prescribed in general practice: a cross-sectional analysis. BMC Health Serv. Res. 7(1), 132 (2007).
    • 6 Bartlett G, Rahimzadeh V, Longo C et al. The future of genomic testing in primary care: the changing face of personalized medicine. Per. Med. 11(5), 477–486 (2014). •• This perspective article provides further details on the importance of primary care in the clinical application of personalized medicine and particularly pharmacogenomics.
    • 7 Vegter S, Jansen E, Postma MJ, Boersma C. Economic evaluations of pharmacogenetic and genomic screening programs: update of the literature. Drug Dev. Res. 71(8), 492–501 (2010).
    • 8 Hajjar ER, Hanlon JT, Artz MB et al. Adverse drug reaction risk factors in older outpatients. Am. J. Geriatr. Pharmacother. 1(2), 82–89 (2003).
    • 9 Burgess MM, O'Doherty K, Socko D. Biobanking in British Columbia: discussions of the future of personalized medicine through deliberative public engagement. Per. Med. 5(3), 285–296 (2008). •• This original research article demonstrates the use of public deliberation as an efficient method for policy input and decision-marking in the field of personalized medicine.
    • 10 Haga SB, Burke W, Ginsburg GS, Mills R, Agans R. Primary care physicians’ knowledge of and experience with pharmacogenetic testing. Clin. Genet. 82(4), 388–394 (2012).
    • 11 Mcguire AL, Caulfield T, Cho MK. Science and society – research ethics and the challenge of whole-genome sequencing. Nat. Rev. Genetics 9(2), 152–156 (2008).
    • 12 Shields AE, Lerman C. Anticipating clinical integration of pharmacogenetic treatment strategies for addiction: are primary care physicians ready? Clin. Pharmacol. Ther. 83(4), 635–639 (2008).
    • 13 Rahimzadeh V, Bartlett G. Genetics and primary care: where are we headed? J. Transl. Med. 12, 238 (2014).
    • 14 Chambers S. Deliberative democratic theory. Political Science 6, 307–326 (2003).
    • 15 Caron-Flinterman JF, Broerse JEW, Bunders JFG. Patient partnership in decision-making on biomedical research – changing the network. Sci. Technol. Hum. Val. 32(3), 339–368 (2007).
    • 16 Cargo M, Mercer SL. The value and challenges of participatory research: strengthening its practice. Annu. Rev. Public Health 29, 325–350 (2008).
    • 17 Tenbensel T. Virtual special issue introduction: public participation in health policy in high income countries – a review of why, who, what, which, and where? Soc. Sci. Med. 71(9), 1537–1540 (2010).
    • 18 Fishkin JS. When the People Speak: Deliberative Democracy And Public Consultation. Oxford University Press, NY, USA (2009).
    • 19 Walmsley H. Biobanking, public consultation, and the discursive logics of deliberation: five lessons from British Columbia. Public Underst. Sci. 19(4), 452–468 (2010).
    • 20 Dryzek JS, Niemeyer S. Foundations And Frontiers Of Deliberative Governance. Oxford University Press, NY, USA (2010).
    • 21 Dryzek JS. Discursive Democracy: Politics, Policy, And Political Science. Cambridge University Press, NY, USA (1990).
    • 22 Gutmann A, Thompson DF. Democracy And Disagreement. Belknap Press of Harvard University Press, MA, USA (1996).
    • 23 De Vries R, Stanczyk A, Wall IF, Uhlmann R, Damschroder LJ, Kim SY. Assessing the quality of democratic deliberation: a case study of public deliberation on the ethics of surrogate consent for research. Soc. Sci. Med. 70(12), 1896–1903 (2010).
    • 24 De Vries R, Stanczyk AE, Ryan KA, Kim SY. A framework for assessing the quality of democratic deliberation: enhancing deliberation as a tool for bioethics. J. Empir Res. Hum. Res. Ethics 6(3), 3–17 (2011).
    • 25 Abelson J, Forest PG, Eyles J, Smith P, Martin E, Gauvin FP. Deliberations about deliberative methods: issues in the design and evaluation of public participation processes. Soc. Sci. Med. 57(2), 239–251 (2003).
    • 26 O'Doherty K, Gauvin FP, Grogan C, Friedman W. Implementing a public deliberative forum. Hastings Cent. Rep. 42(2), 20–23 (2012).
    • 27 Habermas J. Morality and ethical life – does Hegel critique of Kant apply to discourse ethics. Northwest U Law Rev. 83(1–2), 38–53 (1989).
    • 28 O'Doherty K. Synthesising the outputs of deliberation: extracting meaningful results from a public forum. J. Public Deliberation 9(1), 8 (2013).
    • 29 Wendler D. Broad versus blanket consent for research with human biological samples. Hastings Cent. Rep. 43(5), 3–4 (2012).
    • 30 Westfall JM, Mold J, Fagnan L. Practice-based research – “Blue Highways” on the NIH roadmap. JAMA 297(4), 403–406 (2007).
    • 31 Green LW, Ottoson JM, Garcia C, Hiatt RA. Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annu. Rev. Public Health 30, 151–174 (2009).