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Published on 10 July 2009

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Refining therapy and broadening horizons – therapeutics in a changing world

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Expert speakers at the recent EAHP Annual Congress painted visions of the future that served to educate and inspire participants and shape pharmacy practice in the future

Christine Clark
BSc MSc PhD FRPharmS
FCPP(Hon)

Editor
HPE

The European Association of Hospital Pharmacists (EAHP) Congress in Barcelona in March provided much food for thought. The programme looked in depth at some aspects of therapeutics and also included a session on climate change that offered a wider perspective on healthcare in a changing world. The report on page 9 summarises some of the highlights of the congress, but it is worth dwelling for a moment on some of the points that were raised.

Lawrence Lesko talked about pharmacogenomics and personalised medicine – a topic that has featured in numerous conferences in recent years. However, many previous lectures have been little more than a list of genetic variations in drug metabolism culminating in the triumphant display of the Amplichip CYP450® (the first FDA-approved microarray for in-vitro diagnostic use in the United States) – with no clear picture of how the practitioner might put this knowledge into day-to-day practice. Lesko, in contrast, talked the audience through the process of using personal genomic data to adjust dosing in the clinical situation. He also pointed out that the technology to do this for a substantial number of drugs is available now. He argued that fear and ignorance have so far limited the clinical application of genomic data.

However, genetic testing is not complex and interpretation of results is not difficult – it is something that pharmacists could and should be doing. Lesko painted a clear picture of how this could work in practice and how pharmacists need to involve themselves in the interpretation and dose adjustment and in educating other healthcare professionals about the topic. He left the audience in no doubt that pharmacogenomics could help to close some of the critical gaps in good pharmacotherapy – rarely can a therapeutic topic have had such a skilled advocate.

Several important points emerge from this: The real value of a conference is that one lecture from a well-chosen, skilled and articulate speaker can “clear the fog”, inspire the audience and have far-reaching effects. Pharmacogenomics is an important part of the pharmacist’s portfolio – in some ways it is the interesting and practical end of drug metabolism. Finally (and mercifully) the practical applications of pharmacogenomics will not be as difficult to explain to others as pharmacokinetics – a distinct plus for many pharmacists.

Interestingly, Lesko chose warfarin as his key example for genetic testing and dose adjustment. New, safer anticoagulants such as the factor Xa inhibitors and direct thrombin inhibitors threaten to displace warfarin. The report on page 19 describes the impressive results with rivaroxaban (a factor Xa inhibitor) in orthopaedic surgery. However, this is only the beginning – trials are underway examining the use of new anticoagulants in the management of atrial fibrillation, and this could change the face of anticoagulation as we know it.

A lecture on climate change and its implications for infectious disease painted an uncomfortable picture of tropical diseases becoming endemic in hitherto-temperate regions. Rainer Sauerborn argued that a two-degree rise in global temperature is now inevitable and therefore we need to prepare for changing disease patterns. However, this may not be so easy. Arguably, development of drugs for tropical diseases has been underfunded in the past because tropical diseases occur in low-income countries. The impending changes will presumably herald a surge in funding for research and development in this area. Pharmacy (and healthcare systems in general) will need to be ready to respond with new educational initiatives and new services.

Professional conferences bring together practitioners who are interested and committed to their professional development with speakers who are at the cutting edge of research and practice. At the best conferences speakers illuminate the path ahead, paint a vision of future practice and inspire participants to return to their workplace ready to put it all into practice – and that is just what the EAHP Congress this year achieved.

 

 



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