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Güner MD, Ekmekci PE, Kurtoglu B. Variability of Pharmacogenomics Information in Drug Labels Approved by Different Agencies and Its Ethical Implications. Curr Drug Saf 2021; 17:47-53. [PMID: 34315387 DOI: 10.2174/1574886316666210727155227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/28/2020] [Accepted: 05/03/2021] [Indexed: 11/22/2022]
Abstract
AIMS The aim of this study was to determine if there are discrepancies among various agency-approved labels for the same active ingredient and where the labels approved by the Turkish Medicines and Medical Devices Agency (TMMDA) stand regarding the inclusion of PGx and discuss these ethical implications. BACKGROUND The efficacy and safety of drugs can be improved by rational prescription and personalization of medicine for each patient. Pharmacogenomics information (PGx) in drug labels (DL) is one of the important tools for the personalization of medications because genetic differences may affect both drug efficacy and safety. Providing adequate PGx to patients has ethical implications. OBJECTIVE To evaluate PGx in the DLs approved by TMMDA and other national agencies provided by the Pharmacogenomics Knowledgebase. METHODS DL annotations from the Pharmacogenomics Knowledgebase and DLs approved by the TMMDA were analyzed according to information and action levels, which are "testing required", "testing recommended", "actionable", and "informative". RESULTS There are 381 drugs listed in PharmGKB drug label annotations with pharmacogenomics information and 278 of these have biomarkers. A total of 242 (63.5%) drugs are approved and available in Turkey. Of these, 207 (85.5%) contain the same information as in or similar to that in the labels approved by the other agencies. The presence and level of information varied among the DLs approved by different agencies. The inconsistencies may have an important effect on the efficacy and the safety of drugs. CONCLUSION These findings suggest a need for the standardization of PGx information globally because it may not only affect the efficacy and safety of medications but also essential ethical rules regarding patient rights by violating not sufficiently sharing all available information.
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Affiliation(s)
- Müberra Devrim Güner
- Department of Medical Pharmacology, TOBB Economics and Technology, University School of Medicine, Ankara 06560, Turkey
| | - Perihan Elif Ekmekci
- Department of History of Medicine and Ethics, TOBB Economics and Technology, University School of Medicine, Ankara 06560, Turkey
| | - Berra Kurtoglu
- Department of Medicine, TOBB Economics and Technology, University School of Medicine, Ankara 06560, Turkey
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Kumari S, Bhatia T, Mishra NN, Kumari N, Narayanan SS, Malik D, Deshpande SN. Why parents consent to their children's participation in genetic research: A study of parental decision making. Indian J Med Ethics 2020; 4 (NS). [PMID: 31791933 DOI: 10.20529/ijme.2019.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Parents need to be asked to provide informed consent on behalf of their child for participation in genetic research. Decision making for such parents is difficult because ethical challenges in paediatric genetic research studies are different from similar adult studies. This paper focuses on interviews conducted with parents who were asked to consent to their children's participation (or not) in a genetic research study of intellectual disability and/or autism.
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Affiliation(s)
- Sunita Kumari
- Social Worker, Dept. of Psychiatric Social Work, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences (formerly PGIMER) and Dr Ram Manohar Lohia Hospital , New Delhi 110 001, INDIA
| | - Triptish Bhatia
- Senior Research Scientist, Indo-US Projects, Centre of Excellence in Mental Health, Dept. of Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia .Hospital, New Delhi-110001, INDIA
| | - Nagendra N Mishra
- Assistant Professor and HOD, Dept. of Psychology, LS College, Muzaffarpur, Bihar, INDIA
| | - Nupur Kumari
- Junior Research Fellow, SATYAM project, Centre of Excellence in Mental Health, Dept. of Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia.Hospital, New Delhi 110 001, INDIA
| | - Sreelatha S Narayanan
- Senior Research Fellow, Institute of Home Economics, University of Delhi, Delhi, INDIA
| | - Deepak Malik
- Scientist 'B', Division of Sociobehavioural and Health Systems Research, Indian Council of Medical Research, New Delhi 110 001 INDIA
| | - Smita N Deshpande
- Senior Consultant and Professor, Dept. of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi 110001, INDIA
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Weitzel KW, Duong BQ, Arwood MJ, Owusu-Obeng A, Abul-Husn NS, Bernhardt BA, Decker B, Denny JC, Dietrich E, Gums J, Madden EB, Pollin TI, Wu RR, Haga SB, Horowitz CR. A stepwise approach to implementing pharmacogenetic testing in the primary care setting. Pharmacogenomics 2019; 20:1103-1112. [PMID: 31588877 PMCID: PMC6854439 DOI: 10.2217/pgs-2019-0053] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/29/2019] [Indexed: 01/12/2023] Open
Abstract
Pharmacogenetic testing can help identify primary care patients at increased risk for medication toxicity, poor response or treatment failure and inform drug therapy. While testing availability is increasing, providers are unprepared to routinely use pharmacogenetic testing for clinical decision-making. Practice-based resources are needed to overcome implementation barriers for pharmacogenetic testing in primary care.The NHGRI's IGNITE I Network (Implementing GeNomics In pracTicE; www.ignite-genomics.org) explored practice models, challenges and implementation barriers for clinical pharmacogenomics. Based on these experiences, we present a stepwise approach pharmacogenetic testing in primary care: patient identification; pharmacogenetic test ordering; interpretation and application of test results, and patient education. We present clinical factors to consider, test-ordering processes and resources, and provide guidance to apply test results and counsel patients. Practice-based resources such as this stepwise approach to clinical decision-making are important resources to equip primary care providers to use pharmacogenetic testing.
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Affiliation(s)
- Kristin Wiisanen Weitzel
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - Benjamin Q Duong
- Department of Pharmacy, Nemours/Alfred I DuPont Hospital for Children, Wilmington, DE 19803, USA
| | - Meghan J Arwood
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - Aniwaa Owusu-Obeng
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Noura S Abul-Husn
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Barbara A Bernhardt
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Brian Decker
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Joshua C Denny
- Department of Medicine & Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Eric Dietrich
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - John Gums
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - Ebony B Madden
- National Human Genome Research Institute, Division of Genomic Medicine, Bethesda, MD 20892, USA
| | - Toni I Pollin
- Department of Medicine & Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Rebekah Ryanne Wu
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC 27708, USA
| | - Susanne B Haga
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC 27708, USA
| | - Carol R Horowitz
- Department of Health Policy & Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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4
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Consent for emergency treatment: Emergency department patient recall and understanding. Am J Emerg Med 2019; 37:1387-1388. [DOI: 10.1016/j.ajem.2019.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 01/12/2019] [Indexed: 11/21/2022] Open
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Greene M, Master Z. Ethical Issues of Using CRISPR Technologies for Research on Military Enhancement. JOURNAL OF BIOETHICAL INQUIRY 2018; 15:327-335. [PMID: 29968018 DOI: 10.1007/s11673-018-9865-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 05/07/2018] [Indexed: 06/08/2023]
Abstract
This paper presents an overview of the key ethical questions of performing gene editing research on military service members. The recent technological advance in gene editing capabilities provided by CRISPR/Cas9 and their path towards first-in-human trials has reinvigorated the debate on human enhancement for non-medical purposes. Human performance optimization has long been a priority of military research in order to close the gap between the advancement of warfare and the limitations of human actors. In spite of this focus on temporary performance improvement, biomedical enhancement is an extension of these endeavours and the ethical issues of such research should be considered. In this paper, we explore possible applications of CRISPR to military human gene editing research and how it could be specifically applied towards protection of service members against biological or chemical weapons. We analyse three normative areas including risk-benefit analysis, informed consent, and inequality of access as it relates to CRISPR applications for military research to help inform and provide considerations for military institutional review boards and policymakers.
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Affiliation(s)
- Marsha Greene
- Senior Policy Analyst, Peraton, Contracted to the Office of the Under Secretary of Defense for Research and Engineering, 4800 Mark Center Drive, Suite 17E08, Alexandria, VA, 22350-3600, USA
| | - Zubin Master
- Biomedical Ethics Research Program, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Abstract
Vulnerable groups are often excluded from clinical research on the basis of scientific, ethical and practical reasons. Although intended to protect vulnerable people and maintain study integrity, exclusion of vulnerable groups from research through use of standard exclusion criteria may not always be necessary and may result in findings that are not generalisable. Achieving a balance between the competing needs to protect vulnerable people and to make progress in our understanding of disorders and their management through research requires a reconsideration of exclusion criteria and consent processes to ensure vulnerable people are appropriately represented in clinical research. Reasons for development of broad exclusion criteria include both concrete barriers and intangible discouraging factors. This paper examines this situation and its consequences, perceived and real barriers to inclusion of vulnerable people in research, and suggests methods for overcoming these barriers and applying thoughtful exclusion criteria.
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Perlis RH. Abandoning personalization to get to precision in the pharmacotherapy of depression. World Psychiatry 2016; 15:228-235. [PMID: 27717262 PMCID: PMC5032508 DOI: 10.1002/wps.20345] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Effectiveness studies and analyses of naturalistic cohorts demonstrate that many patients with major depressive disorder do not experience symptomatic remission with antidepressant treatments. In an effort to better match patients with effective treatments, numerous investigations of predictors or moderators of treatment response have been reported over the past five decades, including clinical features as well as biological measures. However, none of these have entered routine clinical practice; instead, clinicians typically personalize treatment on the basis of patient preferences as well as their own. Here, we review the reasons why it has been challenging to identify and deploy treatment-specific predictors of response, and suggest strategies that may be required to achieve true precision in the pharmacotherapy of depression. We emphasize the need for changes in how depression care is delivered, measured, and used to inform future practice.
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Affiliation(s)
- Roy H. Perlis
- Center for Experimental Drugs and Diagnostics, Department of Psychiatry and Center for Human Genetic ResearchMassachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
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Haga SB, Mills R. A review of consent practices and perspectives for pharmacogenetic testing. Pharmacogenomics 2016; 17:1595-605. [PMID: 27533720 PMCID: PMC5220438 DOI: 10.2217/pgs-2016-0039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/10/2016] [Indexed: 12/21/2022] Open
Abstract
AIM We aimed to understand consent practices for pharmacogenetic (PGx) testing. METHODS We conducted a literature review and analysis of consent forms from clinical laboratories offering PGx testing. RESULTS Our review of the literature shows a lack of consensus about the need for and type of informed consent for PGx testing. We identified 35 companies offering PGx testing and were able to confirm consent practices for 22 of those. We found a range of variability in the consent practices regarding the consent approach and information disclosed. CONCLUSION Variability in the consent practices among laboratories offering PGx testing mirrors the ambiguous practices and recommendations reported in the literature. Establishing a minimal set of information to be disclosed to patients may help address the disparities in consent practice.
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Affiliation(s)
- Susanne B Haga
- Center for Applied Genomics & Precision Medicine, Duke University, School of Medicine, 304 Research Drive, Box 90141, Durham, NC 27708, USA
| | - Rachel Mills
- Center for Applied Genomics & Precision Medicine, Duke University, School of Medicine, 304 Research Drive, Box 90141, Durham, NC 27708, USA
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Within and beyond the communal turn to informed consent in industry-sponsored pharmacogenetics research: merits and challenges of community advisory boards. J Community Genet 2016; 7:261-270. [PMID: 27492247 DOI: 10.1007/s12687-016-0274-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022] Open
Abstract
The one-size-fits-all paradigm of drug development fails to address inter-individual variability in drug response. Pharmacogenetics research aims at studying the role of genotypic differences in drug response. Recently, the pharmaceutical industry has shown interest to embed pharmacogenetics studies in the process of drug development. Nevertheless, population-based and commercial aspects of such future-oriented studies pose challenges for individually based informed consent (IC). As an exemplar of the communal turn to IC procedures, community advisory boards (CABs) have been integrated into different types of medical research. CABs hold the promise of organizing the relationship between participants and researchers in a more reciprocal and participatory way, offering possible means of overcoming the lapses of individualistic IC. However, the involvement of CABs with pharmacogenetics research might be rife with difficulties, uncertainties, and challenges. The current study first reviews the existing literature to discuss added values and challenges of relying on CABs as a supplement to individually based IC. Then, the particular moral and regulatory landscape of pharmacogenetics research will be delineated to argue that community engagement is both necessary and promising beyond the communal turn to IC processes. Three main features of the landscape include (1) new supportive stances that some regulatory bodies have adopted toward pharmacogenetics research, (2) the motivation of the industry to draw reception and trust from the subpopulations, and (3) the important role of the society in generating and embedding pharmacogenetics knowledge. Finally, some points to consider will be discussed to contextualize relying on CABs within this landscape.
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Foe G, Larson EL. Reading Level and Comprehension of Research Consent Forms. J Empir Res Hum Res Ethics 2016; 11:31-46. [DOI: 10.1177/1556264616637483] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Consent forms continue to be at a higher reading level than the recommended sixth to eighth grade, making it difficult for participants to comprehend information before enrolling in research. To assess and address the extent of the problem regarding the level of literacy of consent forms and update previously published reports, we conducted an integrative literature review of English language research published between January 1, 2000, and December 31, 2013; 35 descriptive and eight intervention studies met inclusion criteria. Results confirmed that developing forms at eighth-grade level was attainable though not practiced. It was found that risks of participation was the section most poorly understood. There was also a lack of consensus regarding the most effective method to increase comprehension. Further research using standardized tools is needed to determine the best approach for improving consent forms and processes.
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Rose D, Papoulias C, MacCabe J, Walke J. Service users' and carers' views on research towards stratified medicine in psychiatry: a qualitative study. BMC Res Notes 2015; 8:489. [PMID: 26416390 PMCID: PMC4587812 DOI: 10.1186/s13104-015-1496-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/21/2015] [Indexed: 02/04/2023] Open
Abstract
Background Approximately 30 % of people with a diagnosis of schizophrenia receive little to no benefit from current medications. There is therefore an urgent need to develop more precisely targeted and effective treatments. Identifying biomarkers to predict response to treatment and stratify patients into groups may be a way forward. However, we know little about service users’ and carers’ attitudes regarding such a ‘stratified medicine’ approach for psychiatry—nor how this might impact on their willingness to participate in stratified medicine research. This paper presents psychiatric service user and carer views on research to develop stratified medicine for treatment resistant schizophrenia, and explores the conditions under which people would be prepared to participate in a trial and their willingness to undergo various research procedures. Methods Participatory methods were used throughout. A consultation was undertaken with an existing Service User Advisory Group (SUAG) in order to establish a topic guide. Service user focus groups were then conducted by service user researchers in Manchester, London and Edinburgh (totalling 18 people) and one carer focus group in London, attended by eight participants. Focus groups were digitally recorded, the transcripts analysed in NVivo 10 using a simple thematic analysis, and quotations de-identified to protect participants. Results The data reflected enthusiasm for the potential of stratified medicine and both service users and carers demonstrated a strong desire to help others. However, some service users and carers feared poor performance on neuropsychological assessments, and reported that certain medication side effects might discourage them from undergoing procedures demanding immobility and concentration. Concerns were voiced that stratified medicine could encourage an overemphasis on biological symptoms, at the expense of psychosocial factors and subjective experience. Conclusions People with experience of treatment resistant schizophrenia would welcome stratified medicine research; however researchers should take into account how such experience might inflect service users’ willingness to undergo various procedures in the context of this research. These results reinforce the value of service user perspectives in the development and evaluation of novel treatment approaches.
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Affiliation(s)
- Diana Rose
- Service User Research Enterprise, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Constantina Papoulias
- Service User Research Enterprise, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - James MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Jennifer Walke
- Service User Research Enterprise, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Abstract
Advances in pharmacogenetic research have improved our understanding of adverse drug responses and have led to the development of pharmacogenetic tests and targeted drugs. However, the extent of the communication process and provision of information to patients about pharmacogenetics is unclear. Pharmacogenetic information may be included in sections of a drug's package insert intended for patients, which is provided directly to patients or communicated via the health provider. To determine what pharmacogenetic information, if any, is included in patient-targeted sections of the drug label, we reviewed the labels listed in the US Food and Drug Administration's Table of Pharmacogenomic Biomarkers in Drug Labels. To date, 140 drugs include pharmacogenetic-related information in the approved label. Our analysis revealed that pharmacogenetic information is included in patient-targeted sections for a minority (n=29; 21%) of drug labels, with no obvious pattern associated with the inclusion of pharmacogenetic information. Therefore, patients are unlikely to learn about pharmacogenetics through written materials dispensed with the drug. Given that there are also inconsistencies with regard to inclusion of pharmacogenetic information in the patient counseling information section, it is also unlikely that patients are receiving adequate pharmacogenetic information from their provider. The inconsistent presence of pharmacogenetic information in patient-targeted sections of drug labels suggests a need to review the criteria for inclusion of information in patient-targeted sections in order to increase consistency and patient knowledge of pharmacogenetic information.
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Affiliation(s)
- Susanne B Haga
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Rachel Mills
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Jivan Moaddeb
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC, USA
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