Pharmacogenetics: Policy needs for personal prescribing

Understanding the relevance of herb-drug interaction studies with special focus on interplays: a prerequisite for integrative medicine

Integrative medicine refers to the blending of conventional and evidence-based complementary medicines and therapies with the aim of using the most appropriate of either or both modalities for ultimate patient benefits. One of the major hurdles for the same is the chances of potential herb–drug interactions (HDIs). These HDIs could be beneficial or harmful, or even fatal; therefore, a thorough understanding of the eventualities of HDIs is essential so that a successful integration of the modern and complementary alternative systems of medicine could be achieved. Here, we summarize all the important points related to HDIs, including types, tools/methods for study, and prediction of the HDIs, along with a special focus on interplays between drug metabolizing enzymes and transporters. In addition, this article covers future perspective, with a focus on background endogenous players of interplays and approaches to predict the drug–disease–herb interactions so as to fetch the desired effects of these interactions.

Can (and will) governments afford personalized medicine?

'Personalized' (or more specifically targeted) medicines promise aging populations important medium- to long-term benefits, including extended healthy life expectancies. But the time and resources needed to deliver such advances may be significantly greater than optimists expect. Given current methodologies, drugs for limited numbers of older patients are also much less likely to be judged cost effective than treatments for more common conditions in younger populations. There is a consequent danger that private and public funding for personalized medicine development will in the future fall to a level that is significantly below the global public's best interests. Policy-makers should be aware of this risk, and take actions to mitigate it. These include minimizing the costs and complexities associated with marketing personalized medicines and linked diagnostic tests, as well as strengthening intellectual property protection in ways that will allow 'rich world' pharmaceutical price moderation, increased innovator security and enhanced treatment access for poorer populations.

Pharmacogenetic testing in the clinical management of schizophrenia: a decision-analytic model

Clinical application of pharmacogenetic testing has been proposed as a means of improving treatment outcomes in psychiatry. The identification of a putative genetic test for better clozapine response in schizophrenia offers an opportunity to evaluate the cost-effectiveness of such testing. The authors performed a cost-effectiveness analysis of a genetic test that may identify individuals with greater likelihood of responding to clozapine treatment. We modeled a target population of schizophrenia patients in an acute psychotic episode, using a lifetime time horizon and societal perspective. Outcome measures included life expectancy, quality-adjusted life expectancy, costs, and incremental cost-effectiveness. Effects of variations in testing parameters were also examined. For a 30-year-old with schizophrenia, applying the pharmacogenetic test and treating those predicted to respond to clozapine with clozapine-first cost US $47,705 per additional quality-adjusted life-year, compared with treating all patients with conventional agents and reserving clozapine for treatment-resistant patients. In 1-way sensitivity analyses, test sensitivity and cost had the greatest impact on the incremental cost-effectiveness. We conclude that pharmacogenetic tests may achieve utility in clinical psychiatry, although their cost-effectiveness depends on several clinical parameters. More consistent reporting of test parameters such as sensitivity and specificity would greatly facilitate assessment of future pharmacogenetic studies.