Academic Review 2024

48 ST EDWARD’S, OXFORD

be weighed against the financial dent it creates in the resources available to the NHS. However, many argue that the investment is worthwhile and that the cost of personalising medicine has been steadily decreasing, making it more and more affordable as well as more beneficial as it is developed. In the future, the cost of personalised medicine is unlikely to be such a limiting factor, increasing its potential to be used more widely in healthcare. “ The effectiveness of any drug must be weighed

The further implementation of personalised medicine in the healthcare system also has a substantial impact on pharmacists. ‘Pharmacists in the NHS are playing an increasingly important role in health technology appraisal and medicines optimisation, helping to ensure that patients have timely access to clinically effective and cost-effective personalised medicines’ (Martini, 2016). The use of pharmacogenetics in day-to-day work is very challenging; many pharmaceutical professionals do not feel confident in their abilities to adapt to personalised prescribing. ‘Many currently practising pharmacists also lack confidence and feel inadequately prepared to apply pharmacogenetics in clinical practice. In a survey of practising community pharmacists, >70% of respondents indicated their confidence in knowledge regarding the Human Genome Project, genetic testing and pharmacogenetics was <50%’ (Kennedy, 2018). The lack of exposure to pharmacogenetics during training is largely to blame for their lack of confidence. This is further demonstrated by another survey which demonstrated that ‘80% of the pharmacists reported that pharmacogenetics was not an integral part of their pharmacy education and almost 70% of the respondents felt that it should be’ (Kennedy, 2018). It is clear that this may be a major element contributing to why the pharmaceutical industry, ‘has been slow to embrace the concept of clinical pharmacogenetics’ (Kennedy, 2018). In order for pharmacies not to be a limiting factor in the further integration of personalised medicine, postgraduate courses in pharmacogenetics should be a requirement for pharmacists who want to practise personalised medicine at a higher level. Furthermore, big pharmaceutical companies that work on drug production will also be impacted. Not only will the integration of personalised medicine into healthcare be more expensive for pharmaceutical companies – ‘Drug development costs may be increased due to the complexities of biomarker analysis and diagnostic development’ (Ayres, 2010) – but the amount of revenue they can generate may also decrease. This is because more effective drugs will reduce trial and error, decreasing the overall number of drugs sold. This may create resistance from the pharmaceutical industry, causing them to be less inclined to adapt to personalised medicine, drastically decreasing the rate of integration of personalised medicine into the NHS. Therefore, an incentive may be needed to encourage pharmaceutical companies to make further progress towards personalised medicine.

against the financial dent it creates in the resources available to the NHS. ”

On top of these issues, we must also factor in how personalised medicine may negatively influence matters such as life insurance (and also health insurance, in countries outside of the UK such as America where healthcare is not free). It is possible to argue that advancements in the integration of personalised medicine within the NHS can help contribute to a decrease in the cost of life insurance by improving early detection as well as treatments of diseases, therefore increasing the life expectancy of individuals. Conversely, greater implementation of personalised medicine may lead to a situation where the cost of life insurance may be raised for certain at-risk individuals who are very susceptible to certain diseases. Life insurance providers may check the susceptibility of individuals applying for life insurance and they may choose to increase their prices for people at high risk. This raises the question as to whether or not life insurance providers should be able to have access to individuals’ genetic tests; it is widely argued that they should not as many consider this unfair.