As a follow on, my local LREC has just received a document from Nuffield Council on Bioethics, about Pharmacogenetics: ethical issues.
This very point is outlined in their summary paras 33 to 36 Responsibilities for test and treatment.
The whole document can be got from their website
www.nuffieldbioethics.org/pharmacogenetics
You can either get the full report (2Mb) or the short guide or summary. Sections on treatment quite sensible, maybe needed to be considered locally under Clinical Governance issues to cover exactly what was being asked by the patient here.
Gary Mascall (Consultant in Clinical Biochemistry)
Clinical Biochemistry Department
Kidderminster Hospital
Worcestershire Acute Hospitals NHS Trust
Tel : 01562 823424 Extn 53465
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-----Original Message-----
From: Chris Florkowski [mailto:[log in to unmask]]
Sent: 22 October 2003 21:40
To: [log in to unmask]
Subject: CY2D6 and Prozac
For CYP2D6 there are more than 50 different alleles. By targeting the 3 most common gene variants (*3, *4, *5), 95% of poor metabolisers can be identified in the Caucasian population.
Until genotyping becomes routinely available, however, 2D6 phenotyping may be helpful in other situations by measuring the ratio of parent compound to metabolite eg for perhexilene (measured by HPLC).
In the future, population-based pharmacogenetic testing will allow more individualized drug treatment and avoid current empiricism. Indeed, it appears that it may already be culpable not to do so.
Chris Florkowski
Christchurch, NZ
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