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Researchers want to widen the range of gene variants used in tests \u00a9 unaihuiziphotography\/Getty Images<\/p>\nUnlock the Editor\u2019s Digest for free<\/p>\n
Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.<\/p>\n
When Ron van Schaik visits his local pharmacy in Rotterdam, he always has two pieces of plastic in his wallet: a credit card to pay for his medicines, and a second card, similar in size and shape, bearing information that will ensure the drugs cure rather than harm him.<\/p>\n
The professor of pharmacogenetics at Erasmus Medical Centre, one of the country\u2019s most prestigious hospitals, is one of tens of thousands of Dutch citizens who carry with them the results of genetic tests which show the speed at which 10 different enzymes in their bodies can metabolise drugs.<\/p>\n
\u201cYou can go to any pharmacist in any small village [in the Netherlands], show the \u2018DNA medication passport\u2019 and tell them which drug you need,\u201d says Van Schaik, \u201cand they will know how to adjust the dose based on your DNA information\u201d.\u00a0<\/p>\n
The \u201cpassports\u201d are a record of so-called \u201cpharmacogenetic\u201d tests that are ordered by a GP or specialist when a Dutch patient is prescribed drugs for which the information would be clinically meaningful. The costs are covered by health insurance.<\/p>\n
The Netherlands is unusually advanced in its approach, but all over the world health systems are becoming aware of the need to take patients\u2019 individual genetic make up into account when prescribing drugs.\u00a0<\/p>\n
As an example, Van Schaik cites Metoprolol, a beta blocker. \u201cIf you have ultrafast metabolism for one particular enzyme\u2009.\u2009.\u2009.\u2009then you will metabolise [the drug] so quickly that it will have hardly any effect.\u201d An alternative drug would then be considered preferable.<\/p>\n
\u201cMy estimate is that 80 per cent of the population will, in their lifetime, be prescribed a drug for which the information of just six enzymes on such a card is already relevant [and there is a need] to adjust the dose based on your personal DNA,\u201d he adds.<\/p>\n
The drive towards individualised prescribing has been made more urgent by an explosion in the number of approved medicines.\u00a0<\/p>\n
Dr Adri\u00e1n Llerena, director of the Extremadura University Biosanitary Research Institute INUBE, likens it to the way in which a rise in the number of cars on the road automatically increases the risk of an accident.<\/p>\n
\u201cThe number of people that die from adverse drug reactions has tripled in the last decade,\u201d he says. \u201cWe are facing a worldwide epidemic.\u201d\u00a0<\/p>\n
The problem receives too little attention from politicians and the public, Llerena suggests. Research that he led in his home region of Extremadura found that as many as 28 per cent of people had suffered at some point in their lives from an adverse drug reaction. \u201cIt\u2019s a very important healthcare issue that people in general are not very much aware of.\u201d<\/p>\n
In June, 2023, the Spanish government agreed that genetic testing must be provided free for patients when a doctor decides to prescribe any one of a group of 65 drugs \u2014 and additional drugs were now being added to that list, he said.<\/p>\n
One question with which Llerena and other researchers are grappling, however, is how to ensure that the genetic tests do not exclude and disadvantage those of non-white ethnicity.<\/p>\n
Researchers want to widen the range of gene variants used in tests \u00a9 unaihuiziphotography\/Getty Images<\/p>\n
At the University of Liverpool\u2019s Institute of Systems, Molecular and Integrative Biology in the UK, Professor Sir Munir Pirmohamed is working to ensure that patients who are given a widely-used group of anti-cancer drugs called fluoropyrimidines do not suffer adverse effects due to their genetic make-up.\u00a0<\/p>\n
Some people have a genetic deficiency of dihydropyrimidine dehydrogenase, an enzyme needed to break the medicine down, so a conventional dose \u201ccan\u2009.\u2009.\u2009.\u2009cause serious toxicity in the body\u201d, he says.<\/p>\n
In up to 1 per cent of people \u201cit can actually lead to death because of the side effects,\u201d he adds. <\/p>\n
In October 2020 came a breakthrough: the NHS agreed to genotype all people who were due to receive the drug. Since then, about 45,000 people a year have been tested. \u201cIf they\u2019ve got one of these changes in their DNA, they get a lower dose\u201d, he says.<\/p>\n
However, although the DNA changes affect all ethnic groups, \u201cthe four variants [of the gene linked to the function of the enzyme] that we test for at the moment are largely derived from white populations. So we\u2019re not testing for all the other different variants that may occur in other populations\u201d, he adds.\u00a0<\/p>\n
Through work funded by the NHS Race and Health Observatory, which has a mission to ensure racial equality in healthcare, Pirmohamed and fellow researchers have identified one DNA change which was only seen in people of African background.\u00a0<\/p>\n
\u201cWe\u2019ve made an application to the NHS that this particular change\u2009.\u2009.\u2009.\u2009should be introduced into the panel\u2009.\u2009.\u2009.\u2009so that we don\u2019t disadvantage [them],\u201d he says, pointing to census data showing that in the UK about 2.4 per cent of the population is of African ancestry.\u00a0<\/p>\n
Pirmohamed says the argument in favour of the work he and his colleagues are doing is both economic and human. By reducing hospital admissions caused by adverse reactions, the genetic testing programme was \u201csaving money\u201d for a cash-strapped NHS.<\/p>\n
But a far greater prize has already been achieved: \u201cI have no doubt that it has saved lives.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"Unlock the Editor\u2019s Digest for free Roula Khalaf, Editor of the FT, selects her favourite stories in this…\n","protected":false},"author":2,"featured_media":97227,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3846],"tags":[267,70,16,15],"class_list":{"0":"post-97226","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-genetics","8":"tag-genetics","9":"tag-science","10":"tag-uk","11":"tag-united-kingdom"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@uk\/114498860857353700","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/97226","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/comments?post=97226"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/97226\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media\/97227"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media?parent=97226"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/categories?post=97226"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/tags?post=97226"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}