Much has been said and written in recent years about the promise of pharmacogenetics.
The vision is one of a world where we will be able to match medications with patients,
maximizing efficacy while minimizing—or eliminating—adverse effects. This vision has
been widely embraced out of a real desire to better help patients. But we are now
some years into the pharmacogenetics enterprise, and we are beginning to accumulate
real-world data in juxtaposition to our perhaps somewhat idealistic expectations.
Some of the assumptions underlying the vision are beginning to be scrutinized more
closely. Can we really match medications with patients when the range of available
treatments is still quite small compared with the range of clinical presentations?
Can genetics really provide the keys? How much of the difference between patients
in efficacy and adverse effects will actually be attributable to differences in life
experience and circumstances that we can neither measure biologically nor address
medically? The technological advances of human genetics over the past decade, along
with the recent availability of large treatment cohorts for study, are beginning to
answer these questions. Pharmacogenetics is being transformed from a small field of
promising leads into one of the foundations of evidence-based medicine. Few specialties
stand to benefit as much as psychiatry, where all of our treatment options are empirical
and the matching of patients with treatments is largely a question of clinical judgment.
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Article info
Publication history
Published online: October 22, 2007
Accepted:
September 19,
2007
Received:
September 18,
2007
Identification
Copyright
© 2007 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.