- Pharmacogenetics gives us the possibility to go to the roots and find
out why certain drugs have side effects and, by finding out those factors,
we can actually prevent that patients get drugs that are not perfect for them.
- What I really want is to achieve that everyone has the possibility of get the
medication with appropriate for their body.
That has been a very big advance in health because of the drugs.
But now we are at the point in the development of technology that it is
possible to see what is ongoing in our genes.
And it's time, I think, to put that information to the doctors,
in order to give me a better medication.
- It's the implementation the point that we're currently focusing on,
and that's going extremely well.
It's the only country where you can go with your DNA information,
considering pharmacogenetics, to any pharmacist, and the pharmacist will
be able to tell you what is the dose for a particular drug that you should take.
In our country, you will have an outcome within a couple of days or maximum one
to two weeks. You can get reliable results fast and you can act upon it.
- We are amongst the few countries in continental Europe where the
implementation of pharmacogenetics is part of the government program.
The government pledged two years ago to implement pharmacogenetics
for polypharmacy and oncology as the two starting areas and
from there move further.
- The State of Qatar has invested in the last 20 years in developing research that
has led to the understanding also of the genetics, specific genetic architecture,
of the people living in those countries.
In this space of pharmacogenomics, I should say that we have engaged down the
path of bringing tools that are DNA based for providing assistance in diagnostics.
- There are still challenges that we have to face.
Awareness of the clinician that it's indeed possible to have this kind
of testing, awareness that there are those recommendations so it's not a test
without any actionability, but you can do something about it.
- Even though the pharmacogenetic information can be found in the products,
specifics of the drugs, the insurance system is reluctant to pay
for the analysis.
Something very, very challenging circles around the knowledge that physicians have
of how to implement pharmacogenetics into their daily life.
Educating physicians is the way to go.
This is something that we need to do.
However, it's way too slow for the implementation.
The other thing that needs to be done is to make reports as obvious and easy
to handle as possible.
- The challenges that we will face in a country such as Qatar are no different
from what you could find elsewhere.
The physicians in Qatar are quite knowledgeable of the potential
of the technologies.
What I believe is a bit of a challenge is to be able to integrate these in the
general practice, in the day to day practice.
It is more a matter of actually conveying to the public that the tools are
now available, and the national health system can implement it.
- I think it's very important to have an interaction to learn from each other what
are the challenges and also learn what are the solutions that were found
in the different countries.
We try to bring together people to exchange information.
The whole idea is to present pharmacogenetics and pharmacogenomics
in such a way that you're not overpromising, but also you will allow
patients and clinicians to benefit from the potential that it really has.
- Easy to use reporting is the most pragmatic and fastest way
to implement pharmacogenetics.
- The test is going to deliver the information about the drugs related to the
illness of the patient, polypharmacy patients.
That is where the complexity becomes too big to be handled in the short time and
in an effective way.
All that has also impact on the cost and it's difficult.
If the doctor gets a very nice report, he can read, he can understand,
and can apply to that patient at that moment.
Then the acceptance is going to be very good.
The most difficult thing will be the interpretation.
And in this interpretation, we need to put efforts together,
all scientific people, also the companies who are doing work
on that, and get to a standardization.
My company is in Germany, in Fürth.
We began our work with scientific papers.
We are coordinating information ourselves.
And we went with this information to the doctors.
We were not using the words doctors are using.
We make the work to translate that from the scientific way
to the doctor's language.
And now doctors are using that, and they are very happy.
- Three areas which I think are very important currently: psychiatry, oncology,
and pain medication.
I think we have a big contribution in psychiatry.
For psychiatry, it's very difficult to estimate whether the drug is working or
not and people suffer from side effects.
And to make sure that they do not suffer in vain from these side effects,
it's good to have pharmacogenetics up front.
The second area I would like to mention: oncology.
Oncology is, of course, very important as well because most of the
drugs there are given to a level as high as possible to insure proper therapy.
Failure of therapy you don't want to have, but toxicity is usually
also dose limiting.
The third area which is very much important is pain.
It's only ethical that we establish up front whether you will benefit from a pain
killing therapy instead of using trial and error that we're currently using.
- The main therapeutic areas it's psychiatry, I would say,
it's internal medicine, it's oncology.
However, there is one area that I think is extremely important and that's the
area of polypharmacy.
The older a person grows, the more likely is the chance to end
up with a whole list of drugs.
Our champion had 43 drugs.
But everything beyond four to five drugs, there are so many drug interactions that
come into play then as well.
And those based on the genetics of that specific person makes it very challenging
to find the right mix of drugs that is right for that specific person.
Polypharmacy is going to be the most difficult area in order to educate
physicians in how to cope and how to adjust the dosing and the prescription
based on the pharmacogenetic report so that we can guarantee a safe situation
for the patient.
- If you have this one patient in front of you suffering from the side effects.
You order a pharmacogenetic test.
You can indeed see that the side effects are indeed explained
by the pharmacogenetic information.
Those clinicians they adopt pharmacogenetics much faster because they
realize they have more patients that may suffer from the same problems.
And then we see the transition from ordering the test when there are side
effects to ordering the test prior for start of certain therapies.
- The technology providers such as Illumina have shown the way
in many ways already.
Beyond DNA based technologies, there may be other omics technologies
which would be useful.
- We are at the beginning of that era which will be possible for everyone
to have the power, the empowerment, to decide on their own health.
And the doctors will gain a completely different role.
They will be giving orientation.
But the responsibility on our own health is going to be our own.