Why Teach Pharmacogenomics; And How Much?

There seems to be some confusion about what a pharmacogenomics course is, and how much we should invest in one. I want to be up front in stating that we need to invest some serious effort here, and the only way to do so is to provide a solid foundational course in this very fast moving field. More recently I was informed of a 2 credit vs 3 credit discussion. I like neither, I like a 3 credit plus one more credit for a lab, but if we cannot give our students that optimum in our very packed curriculum, then we will have to settle for the 3 credits worth.

Here is why:

Pharmacogenomics is required by our accrediting body.

The 2007 accreditation standards set forth the need for education in not just pharmacogenomics, but genomic variability and the genetic basis of disease. In the AACP’s 2007-2008 final report from the “Bylaws and Policy Development Committee”, the educational challenge was further refined:  “personalized medicine, including relevant competencies in cell and systems biology, bioengineering, genetics/ genomics, proteomics, nanotechnology, cellular and tis- sue engineering, bioimaging, computational methods and information technologies”. Our charge is to insure that our students are prepared to be fluent in this emerging field.

Numerous pharmacy schools have decided that they must include more pharmacogenomics in our curriculum.

School after school has determined that there was insufficient coverage or breath of genomic and proteomic material in the curriculum. They have identified modules in a few courses that could be expanded, but the general feeling of the faculty is that improvement is needed and would be part of a new curriculum. Surprisingly as the pharmacogenomic field grows, surveyed faculty are less optimistic that pharmacy covers this area sufficiently.

Pharmacogenomics is not just warfarin and cytochrome P450s

There is a perception that pharmacogenomics can be defined by its most cited cases, warfarin and cytochrome P450 alleles. 

This is not the case.

Pharmacogenomics is an intersection of numerous different fields of study, including (but not limited to) human genetics, protein biochemistry, population biology, evolutionary genomics, molecular biology, pharmacology, systems biology, and toxicology. The perception that one can learn pharmacogenomics by covering a limited number of case studies of warfarin followed up by a review of cytochrome p450 alleles is misfounded, particularly when the majority of individuals asked can’t even define what an allele is, let alone how such information can be assessed clinically. Going forward pharmacists will be in an ideal position within the healthcare system to use, disseminate, and educate their patients on genomic issues. We must train students to be prepared to serve in this role.

We have an opportunity to lead in pharmacogenomics/biotechnology/genetic therapy instruction

One of the most consistently repeated challenges in pharmacogenomics education is the lack of foundation. We have direct experience with this in our current toxicogenomics class, TOX1401. Students are unprepared for concepts that serve as the foundation for pharmacogenomics. Concepts from basic gene expression to genotyping using single nucleotide polymorphisms require considerable educational investment. To be direct the PHS department has worked hard to fit this content into a 3 credit course with an additional 1 credit of lab. Pharmacogenomics now consists not only of fields previously listed but also relies heavily on bioinformatics. Our students need a solid understanding of computational approaches that are already in use from the drug development phase to public health outcomes studies. This is part of a pharmacogenomics course. See the PharmGKB dataset for examples: http://www.pharmgkb.org .

We need to invest now in order to prepare our students

If we do not invest in fully preparing our students for this field we are failing them. We are not discussing a new technology that may show up in a few year, but rather it is here now. Teaching our students that a few gene products have allelic differences and relating this concept to a few drugs is a huge disservice. The field is growing in ways that will shortly include true gene (siRNA) based therapies. We have to invest in a real foundational course taught by professionals who have a deep understanding of the concepts. This sort of approach will insure that our students are prepared to understand new technologies. 

As a school we have an opportunity to lead here, we should. A two credit class is a salve, a 3 credit class at least gives us a shot at getting a foundational understanding. A three credit class and a lab would be better.

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