PHARMACOGENOMICS: an indispensable tool in geriatric care

SQ HIGH SCHOOL ESSAY CONTEST

In the sixth annual High School Essay Contest, SQ asked high school students to write about how biological advancements may improve geriatric care. SQ hopes this experience will encourage and celebrate science communication among future scientists and inspire them to think about biology in a broader context.

PHARMACOGENOMICS: an indispensable tool in geriatric care

2020 FIRST PLACE WINNER: ANJANA SHRIRAM (CANYON CREST ACADEMY)

illustrated by varsha rajesh

In 5 years, every region of the United States is expected to face a shortage of geriatric physicians, according to the Department of Health and Human Services. As the number of geriatric caregivers dwindles and the elderly population grows, improving the overall quality of care for senior patients has become of paramount importance. A pervasive but frequently overlooked cause of mortality in geriatric patients are adverse drug reactions (ADRs).

Since their discovery, clinical drugs– including antibiotics, antivirals, and antiinflammatory agents–have become modern medicine’s most widespread and effective defense against disease, and they play an “in-dispenseable” role in the field of geriatrics. Nearly all chronic conditions are now treated or managed through the use of such drugs. However, the benefits of these medications are often hindered by the potentially lethal complications that can follow.

While ADRs affect people of all ages, geriatric patients are particularly vulnerable because they typically take several medications simultaneously, a practice known as polypharmacy. ADRs can, however, be averted by developing drugs that account for factors such as genetic predisposition, comorbid illnesses, and medical history. According to the U.S. National Library of Medicine, the emerging field of pharmacogenomics aims to combat the increasing prevalence of ADRs in the elderly by combining “pharmacology and genomics to develop…safe medications that will be tailored to a person’s genetic makeup.”

The current method of prescribing medication is described as a “one-size-fits-all” approach, in which everyone suffering from a condition receives identical treatments. The non-specific nature of today’s drug therapy ignores the genetic, biological, and pathological diversity of communities; blindly administering the same drug to individuals with vastly different needs and genetic makeups can have disastrous implications for the health and safety of patients. According to Amanda Hanora Lavan and Paul Gallagher’s paper “Predicting risk of adverse drug reactions in older adults,” the abundance of medical drug use and polypharmacy in geriatric patients also explains why “twice as many patients aged 65 and older [are]…hospitalized because of ADRs…than their younger counterparts.” Furthermore, as described in a 1998 meta-analysis, ADRs can increase geriatric mortality rates by almost 5%, and are between the fourth and sixth leading causes of death, globally.

Pharmacogenomics will drastically reduce ADR mortalities by creating drugs that cooperate with the patient’s genetic, biological, and chemical makeup. Beyond that, the budding field promises to cultivate a more comprehensive outlook on geriatric care by compensating for what our current healthcare system so desperately lacks—a focus on each patient as a unique individual with complex needs. Ultimately, this advancement will allow physicians to assess their patients from a more holistic perspective; by gauging the risks of an ADR prior to one actually occurring, geriatric mortality rates will decrease, and potent drugs can be used with more confidence.

One of the obstacles of this approach, however, is the “marked reluctance of the medical profession to treat the individual rather than the population. A treatment that is suitable for one person may not suit another,” as described by author Matt Ridley in Genome: the Autobiography of a Species in 23 Chapters.

Tailoring treatments to the needs of each patient might seem like a daunting task for both physicians and drug developers, but this innovation does not seek to create millions of new drugs; rather, the goal is to expand drug treatments to accommodate differences in the population, and by doing so, reduce ADRs. Recognizing that humans are more similar than they are different is critical to realizing the feasibility and potential of pharmacogenomics.

As with any gene-related technology, privacy and accuracy are also notable concerns. In order for predictive genetic tests to improve patient care, steps must be taken to ensure the confidentiality and validity of results; false positives and negatives as well as data breaches continue to deter many clinicians from incorporating these tests into practice.

As biological advancements in pharmacogenomics are made, they will be paralleled and bolstered by technological advancements in genomic sequencing and screening. As genomic sequencing becomes a faster, more reliable, and affordable tool, pharmacogenomic therapy will be much more easily integrated into everyday clinical settings. In just two decades, according to genome.gov, the cost of analyzing the entire human genome has plummeted from $100,000,000 to less than $1,000. Furthermore, improved screening techniques and predictive genetic tests will enable clinicians to rapidly and accurately identify genetic risk factors and variants, allowing them to prevent adverse drug reactions in patients.

Much remains to be discovered in this burgeoning field. As pharmacogenomics becomes more widely adopted and tested, flaws and inadequacies will inevitably arise. But one thing is for certain: Used in conjunction with advancements in clinical screening and genomic sequencing, pharmacogenomics will revolutionize medicine as we know it; for our nation’s rapidly expanding geriatric population, it can be the start of a more accessible, safe, and holistic healthcare system.

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