Evolution of Pharmacogenetic Prescribing – Genetically Guided Prescribing By A/Prof Ajeet Singh

Posted on: August 20, 2019
Last Updated: September 12, 2019

A/Prof Ajeet Singh is an academic private psychiatrist whose research has focused on genetically guided prescribing (pharmacogenetics) of antidepressants, particularly the role of the blood-brain-barrier. Dr Singh is the Founder of CNSDose, an academic member of the Clinical Pharmacogenetics Implementation Consortium (CPIC), and member of the Genetic Tests in Psychiatry Taskforce, International Society of Psychiatric Genetics (ISPG).

Author Quotes  

To understand the future, you must understand the past.

It’s interesting that some things don’t lead to outcomes straight away, others a few years later are actually changing what we do about conditions, and life expectancy for cystic fibrosis for some individuals is expected to parallel the normal population.

I believe that the most powerful technologies are the low-tech ones like what’s happening in this room right now – a network of people thinking and sharing ideas.

Summary and slides  

This clip walks us through the evolution of ‘genetic prescribing’ from 1866 to 2015.

A/Prof Singh focuses on six key moments in history. First, in 1983 they found the genetic basis of Huntington’s Disease. However, due to the minimal treatment implications, a common thought is ‘genetics so what’; but clearly the story did not end in 1983. 

In 1985 Kary Mullis developed a technology termed polymerase chain reaction (PCR), whereby thousands to millions of copies of a particular DNA sequence are generated. 

The Human Genome Project began in 1990 and is one of the great feats in exploration history. This international scientific research project aims to identify and map all of the genes in the human genome.  

In 1993, the ultra-rapid metaboliser was born. It identified that people have different types of metabolism based on their genetics, which in turn raised questions such as “how does this affect prescribing medication?” A/Prof Singh suggests that it was ‘the beginning of modern pharmacogenetics in some ways’.  

The most recent evolution in genetic prescribing was in 2015, where Obama introduced the ‘Precision Medicine Initiative.’ 

Take-Home Points  

  • 1993 saw the start of modern pharmacogenetics. 
  • The cost of obtaining empirical evidence-based data has decreased dramatically ensuring more research can now be carried out to answer clinical questions.
  • Not all genetic research results in a cure or better therapeutics. 
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