Dear Dr. Annesley, I found your interview refreshing and inspiring! I wanted to get your take on the future of pharmacogenetics and toxicology. Are there any specific areas in PGx that you think are promising? Thank you!
Thomas Annesley, PhD
Thank you for your question. I will first address the future of toxicology. This is a field that is alive and well and still has many new opportunities. The “good old days” of testing for a small set of abused drugs no longer exist. The traditional menu of immunoassay for 6-8 classes of drugs is very important, but often do not meet the needs of emergency departments, pain clinics, and substance abuse programs. In fact, even the analytical expectations from the laboratory are different. For example, we previously focused our efforts on detecting “medically important” concentrations of drugs in urine and blood. We worried about false positives, and assumed that a negative result may be less detrimental to the patient since it was likely not a toxic concentration. Now we receive requests for drug screens where the clinician needs to know if a patient is properly taking the drug, not necessarily having a toxic reaction, and the consequences to the patient for missing the presence of a drug (e.g., fentanyl, oxycodone, buprenorphine) may mean that a patient is terminated from treatment or falsely accused of diverting the drug. Thus we need to improve our ability to detect both toxic concentrations as well as therapeutic concentrations in urine and blood.The “CSI” effect has also impacted the toxicology laboratory. Both clinicians and the public often expect that the laboratory can detect any substance in a short period of time. This has created an image problem at times, but has also created an opportunity for the laboratory scientist to more effectively consult with clinicians about the power and limitations of toxicology testing. We are an important source of clinical information as well as analytical data. I see an increased interest from clinicians for help from the clinical laboratory, and a clear recognition of such a collaborative effort.As far as pharmacogenetic/pharmacogenomic (PGx) testing, this is a field that is still finding its identity and niche in medicine. My opinion is that it an important area, but one that will develop slowly and will need to show more clinical data of its utility in specific situations. Once 2-3 clear uses for cost effective, high impact PGx testing are recognized and accepted, this field will then rapidly expand. Pharmaceutical companies have already adapted PGx testing to the development of new drugs, and the best applications based on new areas such as ethnic differences in patients. This is an important area of research, and one that presents great opportunities as we increase the use of drugs around the world for life-threatening disease in both developing countries. If you want to make an impact, help identify which patients will respond best to which drugs, and at what doses.