Clinical Pharmacy in the Genomic Era

Over a century ago Gregor Mendel investigated quantitatively how physical traits of plants were passed on from one generation to the next. Soon after, William Bateson and Archibald Garrod showed the relevance of Mendel’s findings to human disease. Pharmacists have throughout history marketed themselves as experts who could treat disease with specific medicines. Their claims were however poorly validated until Louis Pasteur and Robert Koch established the microbial aetiology of many diseases. Effective antimicrobial agents and immunotherapies soon became available for an expanding range of infections, and personalisation of treatment became possible through sensitivity testing. Later, a greater understanding of the molecular pathogenesis of non-microbial diseases led to the development of effective drugs, such as antihypertensives and anticoagulants. As a result, current pharmacopoeias bear no resemblance to their predecessors cluttered with predominantly useless drugs. With the unravelling of the double helical structure of DNA and greater understanding of its implications for health and disease, pharmacopoeias are being rewritten again. The new drugs enable an unprecedented level of individualisation of therapy. To optimise the promise of these drugs, input from a new generation of well-informed clinical pharmacists is needed. In this presentation, we identify some of these developments, and where input from pharmacists is most likely to be required. Will clinical pharmacists deliver?