Pharmacogenomics: Social, Ethical, and Clinical Dimensions
Edited by Mark A. Rothstein.
Hoboken,
NJ:John Wiley & Sons, 2003. 320 pp. ISBN: 0 471-22769-2, $59.95 cloth.
This interesting and timely book presents a multidisciplinary analysis of
the scientific, clinical, economic, ethical, social, and legal implications
of pharmacogenomics research and treatment. Some of the individual chapters
analyze societal issues against an incomplete understanding of what pharmacogenomics
is and what it is not. However, the major strength is the comprehensive approach
(both in topics covered and in their authors) that is rarely found in a single
book. The multidisciplinary author and topic coverage is quite enlightening
and required reading for those who focus only on the science and do not consider
the societal implications of their research. Many scientists are so focused
on their research that they do not appreciate the larger issues. This book will
help them understand the implications of this research for society at large
and for different subsets of society. Readers can evaluate for themselves which
implications are realistic and which are not, but scientists need to be aware
of all the societal implications that well-educated nonscientists describe from
their unique and more global perspectives.
Pharmacogenomics is commonly defined both as the genetic basis for differences
among individuals in drug response and/or toxicity (often referred to as pharmacogenetics)
and the use of genomic information for the discovery and development of drugs
with new and more specific targets. Many chapters describe the economic, ethical,
social, and legal implications of genetic differences among individuals in drug
toxicity or drug response. Knowledge of these genetic differences is relevant
for the administration of certain drugs; such differences should be resolved
by substitution of another drug or dose as health care providers are better
informed. Although pharmacogenetics is an important subset of genetics research,
there clearly are different societal implications for an individual exhibiting
genetic susceptibility to an adverse reaction or inadequate response from a
drug as opposed to genetic predisposition to disease. The other important aspect
of pharmacogenomics--the use of the genomic information to identify new and
more precise drug targets--does not fit the general public perception of "genetic"
research, and the societal implications of identifying these new drug targets
from genomic information are not covered as well in this book. Some chapters
conclude that "pharmacogenomics-based" drugs will be more costly, so their use
will have wide-ranging economic, ethical, and social implications. However,
other chapters argue that pharmacogenomics has clear potential to lower development
costs for new drugs compared to those for new drugs derived from empirical approaches,
and conclude that it has the potential to change the course and outcomes of
many morbid and fatal diseases that generate enormous economic costs in health
care expenditures, human suffering, lost productivity, and human suffering.
Most scientists would agree, logically, with the latter view.
The multiauthor text is divided into five parts. Part I is an introductory
section that describes public attitudes about pharmacogenomics and provides
a scientific primer on the subject. The first chapter describes the results
of a public survey on pharmacogenomics and might be better placed as an appendix
to the book. The second and third chapters are well-written overviews of pharmacogenomics
built upon the two fundamental scientific disciplines of pharmacology/toxicology
and population genetics. Part II describes consequences of pharmacogenomics
on minorities, drug development, drug regulation, genetically guided therapy,
and intellectual property. Part III describes clinical applications, medical
liability, and applications for health care delivery by pharmacists. Part IV
describes economic, social, and constitutional implications of pharmacogenomics.
Two chapters focus on the implications for minorities. Part V includes an exceptionally
well-written epilogue that provides context and unifies the book as a whole.
Readers might be well advised to skip the first chapter (the public survey)
and to read the final epilogue both first and last.
David W. Hein
David W. Hein is the Peter K. Knoefel Professor and Chairman of the Department
of Pharmacology and Toxicology, Distinguished University Scholar, and Director
of the Molecular Epidemiology Group of the James Graham Brown Cancer Center
at the University of Louisville School of Medicine.
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