Education in personalized medicine

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Personalized medicine involves medical treatments based on the characteristics of individual patients, including their medical history, family history, and genetics. Although personal genetic information is becoming increasingly important in healthcare, there is a lack of sufficient education in medical genetics among physicians and the general public. [1] [2] [3] For example, pharmacogenomics (genetic factors influencing drug response) is practiced worldwide by only a limited number of pharmacists, although most pharmacy colleges in the United States now include it in their curriculum. [3] It is also increasingly common for genetic testing to be offered directly to consumers, who subsequently seek out educational materials and bring their results to their doctors. [1] Issues involving genetic testing also invariably lead to ethical and legal concerns, such as the potential for inadvertent effects on family members, increased insurance rates, or increased psychological stress. [4] [5]

Contents

Training

As of 2009, the primary of the care physicians did not have adequate training in genetics or genomics. [2] Although medical school curricula typically include medical genetics, fewer than half offer a standalone course, and the emphasis on practical applications is weak. [1] [2] [6]

In the United States, Stanford University was the first medical school in the United States to offer a course teaching the interpretation of genetic data. [7] Students were able to study their own genotypes, determined using commercially available genotyping platforms (23andMe or Navigenics). [8] Although there was skepticism that this would improve educational outcomes, [8] a survey later showed that this had increased students’ enthusiasm for the subject. [9] A similar class is offered at Mount Sinai School of Medicine, launched in 2012, in which students have the option of analyzing their entire genome sequence instead of only their genotype. [10] [11]

Personal genotyping and education

In 2010, the University of California, Berkeley offered entering students a genetic test for SNPs affecting alcohol, lactose, and folate metabolism. [12] [13] The goal was “to spark discussion during orientation on how genetic testing works, the results of the students' tests and their decisions on whether or not to participate.” [8] However, criticism of the program led to an informational hearing by the California State Committee on Higher Education, and a bill was introduced by Chris Norby to prevent California state universities from genetically testing their students. [14] [15] The California Department of Public Health concluded that the program constituted clinical testing, and the university released only aggregate information instead of personal results. [16] [17]

As described in the preceding section, in some courses on personalized medicine, students have been able to study their personal genetic information. For the Stanford course, which was designed for graduate and medical students, a review was conducted in 2009-2010 by a “joint genotyping task force” including research and clinical faculty, biomedical ethicists, genetic counselors, and legal counsel. [4] [12] The recommendations adopted included: making genetic testing optional (with instructors blinded to the choice of the students), strict data confidentiality (only aggregate data was made available during discussions), incorporation of lectures discussing issues related to personal genotyping, and availability of genetic counseling to students if necessary. [4]

See also

Related Research Articles

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<span class="mw-page-title-main">Genetic testing</span> Medical test

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<span class="mw-page-title-main">Victor A. McKusick</span> American geneticist

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<span class="mw-page-title-main">Pharmacogenomics</span> Study of the role of the genome in drug response

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<span class="mw-page-title-main">Genome-wide association study</span> Study of genetic variants in different individuals

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<span class="mw-page-title-main">Whole genome sequencing</span> Determining nearly the entirety of the DNA sequence of an organisms genome at a single time

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Elective genetic and genomic testing are DNA tests performed for an individual who does not have an indication for testing. An elective genetic test analyzes selected sites in the human genome while an elective genomic test analyzes the entire human genome. Some elective genetic and genomic tests require a physician to order the test to ensure that individuals understand the risks and benefits of testing as well as the results. Other DNA-based tests, such as a genealogical DNA test do not require a physician's order. Elective testing is generally not paid for by health insurance companies. With the advent of personalized medicine, also called precision medicine, an increasing number of individuals are undertaking elective genetic and genomic testing.

Personalized genomics is the human genetics-derived study of analyzing and interpreting individualized genetic information by genome sequencing to identify genetic variations compared to the library of known sequences. International genetics communities have spared no effort from the past and have gradually cooperated to prosecute research projects to determine DNA sequences of the human genome using DNA sequencing techniques. The methods that are the most commonly used are whole exome sequencing and whole genome sequencing. Both approaches are used to identify genetic variations. Genome sequencing became more cost-effective over time, and made it applicable in the medical field, allowing scientists to understand which genes are attributed to specific diseases.

References

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  3. 1 2 McKinnon, R.; Anderson, C. (2011). "Transforming Pharmaceutical Education to Accelerate the Acceptance and Implementation of Personalized Medicine". American Journal of Pharmaceutical Education. 75 (6): 107. doi:10.5688/ajpe756107. PMC   3175667 . PMID   21931445.
  4. 1 2 3 Salari, K.; Pizzo, P. A.; Prober, C. G. (2011). "Commentary: To Genotype or Not to Genotype? Addressing the Debate Through the Development of a Genomics and Personalized Medicine Curriculum". Academic Medicine. 86 (8): 925–927. doi: 10.1097/ACM.0b013e3182223acf . PMID   21795901.
  5. ↑ Robertson, J. A. (2003). "The $1000 Genome: Ethical and Legal Issues in Whole Genome Sequencing of Individuals". The American Journal of Bioethics. 3 (3): 35–36. doi:10.1162/152651603322874762. PMID   14735880. S2CID   15357657.
  6. ↑ Thurston, V. C.; Wales, P. S.; Bell, M. A.; Torbeck, L.; Brokaw, J. J. (2007). "The Current Status of Medical Genetics Instruction in U.S. And Canadian Medical Schools". Academic Medicine. 82 (5): 441–445. doi: 10.1097/ACM.0b013e31803e86c5 . PMID   17457062.
  7. ↑ Kathryn Roethel (July 12, 2010). "Stanford genotype class asks: What's your type?". SFGate. Retrieved 14 May 2013.
  8. 1 2 3 Ferris Jabr (September 24, 2012). "Exposing the Student Body: Stanford Joins U.C. Berkeley in Controversial Genetic Testing of Students". Scientific American. Retrieved 14 May 2013.
  9. ↑ Vernez, S.; Salari, K.; Ormond, K. E.; Lee, S. S. O. J. N. (2013). "Personal genome testing in medical education: Student experiences with genotyping in the classroom". Genome Medicine. 5 (3): 24. doi: 10.1186/gm428 . PMC   3706781 . PMID   23510111.
  10. ↑ "Student Physician, Sequence Thyself". Genome Web Daily News. October 10, 2012. Retrieved 14 May 2013.
  11. ↑ Monya Baker (October 11, 2012). "Personal genomics in the classroom: Students sequence themselves". Nature News Blog. Retrieved 14 May 2013.
  12. 1 2 "A DNA education". Nature. 465 (7300): 845–846. June 16, 2010. Bibcode:2010Natur.465R.845.. doi: 10.1038/465845b . PMID   20559338 . Retrieved 14 May 2013.
  13. ↑ Tamar Lewin (May 18, 2010). "College bound, DNA swab in hand". Nature. Retrieved 14 May 2013.
  14. ↑ Rachel Gross (August 11, 2010). "UC Berkeley DNA testing goes before state committee". Berkeleyside. Retrieved 14 May 2013.
  15. ↑ "California Legislation Seeks to Bar UC Berkeley's Genetic Testing Plans". Genome Web Daily News. July 14, 2010. Retrieved 14 May 2013.
  16. ↑ Alla Katsnelson (August 12, 2010). "State halts UC Berkeley's gene testing plans". Nature News Blog. Retrieved 14 May 2013.
  17. ↑ Gina Shaw (February 2012). "The Right Type: Personal Genetic Testing in the Medical School Curriculum". AAMC Reporter. Retrieved 14 May 2013.
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