Pharmacogenomics: out of the lab and into the community

Pharmacogenomics is the study of the inherited basis of differences in response to drugs. These interindividual differences are often more than tenfold; a 'slow metabolizer' or 'low-responsive' individual might therefore require ten times less than the recommended dose of a drug than a 'rapid metabolizer' or 'high-responsive' person, and the slow metabolizer is often more likely to experience drug toxicity than a rapid metabolizer. Our knowledge is developing rapidly to the point that the physician will soon use DNA-based tests to aid in decision-making with respect to the most appropriate drug and dosage given to each patient. If the patient's DNA is available, however, what boundaries should be placed on that DNA? If the patient's genotype becomes known to the physician (and presumably to the patient him- or herself), what ethical questions might arise and how will they be resolved? This article discusses these issues and outlines some of the possible solutions.