Context and Background

1. PharmGKB: The Pharmacogenetics and Pharmacogenomics Knowledge Base:
2. Opportunities For Pharmacogenomics and Personalized Medicine - Dr. Altman's Tech Talk at Google

We highly recommend viewing the tech talk video first, as that provides a good context for the interview.

1. Kromosoft (KS): Pharmacogenomics (PG) is paving the way for individualized (“genome informed” treatments). Do you envision that the next level of individualization comes at the ethnic group level, or do you envision that the ethnic group can be bypassed leading to a complete individualized approach?

   Dr. Russ Altman (RA):
   I both think and hope that we will bypass the ethnic group level, and will be making decisions at a more individual level. All polymorphisms exist in all ethnic groups (though with varying frequencies). It is easier and cheaper to check for particular SNPs (Single Nucleotide Polymorphisms) in individuals.

   KS: Not only better, but cheaper as well?
   RA: Yes, certainly genotyping at the SNP level is. Genotyping in general is becoming cheaper. Full sequencing is still expensive and probably 5-10 yrs away, but genotyping is already available.

2. KS: Phenotype is a function of genetics and environment. However, as a direction for personalized medicine, we are approaching PG, that is, treatment that is based on genotype. Could it be also be possible to consider individualized treatment based on phenotype? For instance, going back to CYP2D6/Codeine example, it is possible that a person without a specific polymorphism in the gene still cannot metabolize codeine, because of having lived in certain environment that affects the function of the enzyme? Codeine would be ineffective for such an individual as well, though that would not be reflected in that individual’s genome.

3. KS: Similar to the study on Bidil, which ultimately showed benefits of a drug for a subgroup of patients, do you think that in many of the studies that showed inconclusive results regarding the drugs or other treatments, we could go back to some of those and try to find out if there was a subgroup that demonstrated some benefits?

4. KS: What areas of medicine do you think PG could be (or is) affecting first and the most? Could you give an example?

5. KS: You gave some statistics of pharmgkb (http://www.pharmgkb.org/) website. Is it in the format that it could be directly applicable in clinical practice, or would you say that pharmgkb is more of a database for other informaticians to review and then create some information extracts for clinicians?

6. KS: We also have a fair bit of student/emerging scientist population. What 3-4 publications/discoveries or review articles within last couple of years would you recommend for any of them Pharmacogenomics?

7. KS: Finally, what role do you see independent research companies playing in the pharmacogenomics vertical, which is largely, at least in the US, an area with unclear policies, or do you think this a playing field for large drug companies only?