In addition to the incompleteness and inaccessibility of scientific evidence, socioeconomic factors have probably hindered translation of the science into clinical practice.59 While clinical data increasingly suggest that characterization of genetic variability in drug disposition and response, particularly for drugs with low safety margins, would improve patient care, the cost of genotyping large populations at risk as well as the practice efficiency, education of physicians and patients, and data security remain undetermined and need to be assessed if gene-based drug prescribing is to succeed.
At present, two main factors appear to affect the clinical realization of gene-based drug prescribing: compelling scientific evidence, a force tending to advance this process, and unproven economic benefits, a force tending to retard the process. Wilke et al. explored some of the issues relevant to prospective gene-based therapy in the context of three drug classes that are widely used in medical practice, PPIs antiulcer therapy, anticoagulation by coumarin drugs, and statin hypolipidemic therapy.59
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