The science of genomics is set to become a bigger part of healthcare – and industry expert Dr Joanne Hackett says community pharmacists must start equipping themselves with knowledge about this potentially game-changing technology.
Dr Hackett who is Head of Genomic and Precision Medicine at IQVIA and former Chief Commercial Officer at Genomics England, spoke about the subject as the main guest at NPA’s first Centenary workshop on the future of Community Pharmacy, which took place on 13 July.
Many people, she explained, are familiar with “consumer ancestry tests”, which is one application of genomics.
“They originally were marketed more for the ancestry side as opposed to a clinical diagnosis and because it's direct to consumer, it can't actually be designated as a clinical diagnosis,” says Dr Hackett.
“Soon people will get the direct-to-consumer tests done because they're interested in their own health and when they get a report back they want to take it to someone to help them understand it, and that might be community pharmacists, or it might be their doctor.”
She says genomics has allowed people to talk more freely about their own health.
“It's allowed people to explore ancestry and to look for particular areas in their own bodies to see if something appears to be wrong.
“It still leaves a lot to be desired because of the fact that it's not really regulated and there's not really a clinical diagnosis….I do think that there's an opportunity for community pharmacy when we think about that.”
Netherlands case study
In the Netherlands, some community pharmacies make sure individuals are responding to drugs correctly via a genetic test.
“It's not the whole genome being tested, it's either a single gene or a couple of genes,” says Dr Hackett.
“These are quite cost effective and not a very expensive endeavour and you can see very quickly how a person is going to respond and whether or not you need to adjust the dosage.
“Nobody really likes to pay for prevention but let's prevent people from getting the wrong medication, and if they're already ill let's not add to that as well.”
Patients in the country carry “a little credit card” item with them, which allows their information to be stored, says Dr Hackett.
"There's definitely an opportunity for the UK to be a little bit more innovative when it comes to rolling something like this out.”
She added that a small upfront investment would “definitely provide a return”.
“We would be avoiding a lot of adverse drug reactions and hopefully avoiding deaths as well.”
When it comes to relating to patients on genome testing, Dr Hackett believes community pharmacists are the ideal health care professionals to spearhead the service.
“The reason why I think community pharmacy is probably the best home for it is because of the trust issue and I think individuals feel that connection. This is why I also think we can use that as a springboard to be able to get individuals to understand that there's a huge amount of value in outcomes data, when to comes to genome screening and testing.
“I used to jokingly say back in the day when we had those photo booths when you'd go in with your USB key in a pharmacy and get your pictures printed - why can't the USB effectively be your Fitbit [with your health records] and why can't the photo booth effectively almost be a data repository?
“I do think that there's a certain amount of information that people are willing to trade to get tailored healthcare.”
On the logistics
There are various things to consider when getting into the sphere of genome testing and one of them is regulation and compliance and the element of lab testing and sequencing.
“We need to think about what would we have to be worried about for compliance purposes and looking at what regulations need to be adhered to,” explains Dr Hackett.
“Is it expensive? How difficult is it? Do you need a safety officer?”
She believes the logistics side of things can be done more easily if community pharmacies “banded together” like they do in the Netherlands.
“I think that there's certainly an economic upside for community pharmacy to be involved in this and I’m not saying that you're going to set up a lab in the back and have your own sequencing facilities there, but there's probably ways that you could do that.
“You are a community of pharmacies and therefore banding together and having an outsourced depot of some description where all the sequencing happens, could work. I’m sure that the cost effectiveness of that is massive and that's how Genomics England was able to run a national genomics programme .”
She added: “There are a lot of things you wouldn't have to do on your own and there's a lot of infrastructure that already exists in the UK because we are very genomically-enabled. The question is how can we take advantage of some of the things that are already sitting there? We can leverage that but have community pharmacies as the front door to anything pharmacogenomic.”
Nick Kaye, NPA vice chair who was chairing the discussion with Dr Hackett during the webinar says the government must now start to act and fulfil its proposal in its 2019 Green paper of embedding genomics in routine healthcare.
He said: “This is a great time to be having genomics testing started in community pharmacy. We are perfectly located in urban city areas to rural villages and have become the fabric of local communities. Pharmacists are medicines experts and they are essentially scientists, so why don’t we extend their remit further, to include the science of genomics? In this age of patient choice and inclusivity, we need to be helping individuals by tailoring their medication to their needs - and one way this can perhaps be done is through genomic testing.”