Editing Pharmacogenomics (section)

== Challenges ==

[[File:Pharmacogenomics challenges from research to practice.jpg|thumb|upright=2| Consecutive phases and associated challenges in Pharmacogenomics.<ref name="sven2007">{{cite journal | vauthors = Swen JJ, Huizinga TW, Gelderblom H, de Vries EG, Assendelft WJ, Kirchheiner J, Guchelaar HJ | title = Translating pharmacogenomics: challenges on the road to the clinic | journal = PLOS Medicine | volume = 4 | issue = 8 | pages = e209 | date = August 2007 | pmid = 17696640 | pmc = 1945038 | doi = 10.1371/journal.pmed.0040209 | doi-access = free }}</ref>]]

Although there appears to be a general acceptance of the basic tenet of pharmacogenomics amongst physicians and healthcare professionals,<ref name="pmid22278335">{{cite journal | vauthors = Stanek EJ, Sanders CL, Taber KA, Khalid M, Patel A, Verbrugge RR, Agatep BC, Aubert RE, Epstein RS, Frueh FW | display-authors = 6 | title = Adoption of pharmacogenomic testing by US physicians: results of a nationwide survey | journal = Clinical Pharmacology and Therapeutics | volume = 91 | issue = 3 | pages = 450–458 | date = March 2012 | pmid = 22278335 | doi = 10.1038/clpt.2011.306 | s2cid = 21366195 }}</ref> several challenges exist that slow the uptake, implementation, and standardization of pharmacogenomics. Some of the concerns raised by physicians include:<ref name="Pharmacogenetics and Pharmacogenomics Factsheet.">{{cite web |title=Center for Genetics Education |url=http://www.genetics.edu.au/Publications-and-Resources/Genetics-Fact-Sheets/pharmacogenetics-pharmacogenomics=2014-09-03}}{{Dead link|date=May 2020|bot=InternetArchiveBot|fix-attempted=yes}}</ref><ref name="pmid22278335" /><ref name="pmid22689709">{{cite journal | vauthors = Ma JD, Lee KC, Kuo GM | title = Clinical application of pharmacogenomics | journal = Journal of Pharmacy Practice | volume = 25 | issue = 4 | pages = 417–427 | date = August 2012 | pmid = 22689709 | doi = 10.1177/0897190012448309 | s2cid = 1212666 }}</ref>

* Limitation on how to apply the test into clinical practices and treatment;
* A general feeling of lack of availability of the test;
* The understanding and interpretation of evidence-based research;
* Combining test results with other patient data for prescription optimization; and
* Ethical, legal and social issues.

Issues surrounding the availability of the test include:<ref name="sven2007" />
* ''The lack of availability of scientific data'': Although there are a considerable number of drug-metabolizing enzymes involved in the metabolic pathways of drugs, only a fraction have sufficient scientific data to validate their use within a clinical setting; and
* ''Demonstrating the cost-effectiveness of pharmacogenomics'': Publications for the [[pharmacoeconomics]] of pharmacogenomics are scarce, therefore sufficient evidence does not at this time exist to validate the cost-effectiveness and cost-consequences of the test.

Although other factors contribute to the slow progression of pharmacogenomics (such as developing guidelines for clinical use), the above factors appear to be the most prevalent. Increasingly substantial evidence and industry body guidelines for clinical use of pharmacogenetics have made it a population wide approach to precision medicine. Cost, reimbursement, education, and easy use at the point of care remain significant barriers to widescale adoption.