Pharmacogenetics--expectations and reality

doi:10.1136/bmj.329.7456.4

BMJ 2004;329:4-6 (3 July), doi:10.1136/bmj.329.7456.4

Editorial

Pharmacogenetics—expectations and reality

Drug response and toxicity depend on genes, environment, andbehaviour

The first 150 words of the full text of this article appear below.

Thirty years have passed since Mike Rawlins, the current chairmanof the National Institute for Clinical Excellence (NICE), coauthoreda small but perfectly formed book entitled Variability in HumanDrug Response.¹ In the interim we have witnessed the waxingand waning of clinical pharmacology and the inexorable riseof genomic medicine. Genomic medicine has generated many expectationswith regard to the advent of "personalised medicine" and "individualisedprescriptions," fuelled by the pace of technological advancesin genotyping; enthusiasts extrapolating beyond small proofof principle and retrospective studies; and a few apparent successstories, such as the treatment of breast cancer with trastuzumab(Herceptin) and of HIV with abacavir (Ziagen).

But the promise of pharmacogenetics has largely remained unfulfilled.In general, drug response and toxicity are likely to be a complexfunction of the influence of many genes interacting with environmentaland behavioural factors. Trastuzumab is effective in only the. . . [Full text of this article]

Geoff Tucker, professor of clinical pharmacology

Academic Unit of Clinical Pharmacology, Pharmacokinetics and Pharmacogenetics Group, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF (g.t.tucker@sheffield.ac.uk)

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