There remains a lag in the application of PGx in the clinical setting, especially in countries like India which has a multi-ethnic diversity. The scope for PGx tests is unprecedented here in the clinical setting. This article delves into identify the level of awareness for PGx testing in the medical community in India and the steps that can be taken to bring PGx testing to the mainstream.
Study 1:
In the first study by Agrawal et al, 2021, conducted in a Chattisgarh Medical college where 138 students of 2nd year MBBS participated, most students had a good understanding of pharmacogenomics and its relevance, though some gaps remained. Many were unaware that pharmacogenomic variations in drug targets, metabolizing enzymes, and transporters affect drug therapy. Similarly, a significant number of students couldn't relate how pharmacogenomic knowledge could reduce drug development costs or the availability of pharmacogenomic tests in India. An Internet search did not reveal any studies in India that collected healthcare students' feedback on pharmacogenomics and its incorporation into medical education. Textbooks and the Internet were primary sources of pharmacogenomics knowledge. This result was very similar to studies conducted in the USA and Ghana, where medical students and doctors learnt about pharmacogenomics from colleagues and the Internet.
Only 5% of students felt that pharmacogenomics should not be part of their curriculum, they might have felt that it would increase their study burden or lacked confidence and awareness about the relevance of pharmacogenomics in clinical practice.
53% of students felt that pharmacogenomics information is likely to decrease ADRs and should be linked to pharmacovigilance for better drug safety.
68% believed that pharmacogenomics knowledge would reduce drug development costs. Many drugs fail to emerge as therapeutic agents due to efficacy failure or ADRs, leading to the termination of clinical trials and financial losses for pharmaceutical companies.
57% of students were aware that genetic information is required on some drug labels according to the FDA.
82% of students were unaware if pharmacogenomic screening is available in India, although such tests are now offered by both government institutes and private laboratories.
Students were interested in having their pharmacogenomic profile and would volunteer for personal pharmacogenetic testing if given the opportunity
Study 2:
In this study by Sharanya et al, 2021, the survey was conducted on a group of 73 physicians in Chennai to learn about their knowledge of PGx tests. The results showed that the participants had a vague understanding of PGx but were enthusiastic to learn more about it by attending follow-up sessions or short lectures.
Many medical professionals expressed an interest in further exploring the field to better understand its strengths and limitations within medicine. There was a notable inclination among them to incorporate pharmacogenomics (PGx) tests into their practices, even if they weren't sure how frequently they would prescribe these tests.
Obstetricians/gynecologists (ObGyn) and internal medicine (IM) physicians, in particular, showed a strong interest in utilizing PGx tests.
The majority of respondents did not view knowledge of legal regulations and insurance coverage as crucial for practicing PGx.
A minor concern among respondents was the lack of a suitable environment and infrastructure for conducting PGx tests. This could either reflect a lack of awareness about the need for costly laboratories or a high level of confidence that these challenges could be addressed with time and experience.
Conclusion:
Although the studies had a small sample size, the message is loud and clear:
Incorporation of Pharmacogenomics education is important at all levels of the medical curriculum.
Regular educational sessions to update healthcare professionals about the available screening tools and biomarkers are necessary.
There is a need for enhanced resource materials, ideally in electronic format, to boost the application of genomics in clinical care.
Most importantly, implementation of awareness programs for patients and the public needs to happen, to ensure that clinicians are confident in their practice and so that patients feel assured that they are receiving the right tests and treatment.
References:
Agrawal M, Kirtania L, Jha A, Hishikar R. Students' knowledge and views on pharmacogenomic education in the medical curriculum. Indian J Pharmacol. 2021 Jan-Feb;53(1):19-24. doi: 10.4103/ijp.IJP_495_19. PMID: 33975995; PMCID: PMC8216119.
Sharanya Shre ES, Ravi S, Ezhil Arasan R. Knowledge Attitude and Practice Study of Pharmacogenomics amongst Physicians of a Major Indian Metropolitan City. J Clin Pharmacol Ther. 2021;2(1):1014.
-Written by Sohni Tagore
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