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Online First                                                                                                                      Indian J Pharm Drug Studies | 1  

 

Review Article  

PRECISION MEDICINE AND CLINICAL PHARMACISTS 

Janice Jacson Mandumpala 

Pharm D intern, Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, Ernakulam, Kerala, India 

ABSTRACT 

The term "bedside pharmacist" also applies to clinical pharmacists. Pharmacists are in a position to take the lead in pharmacogenomic 

testing, clinical interpretation of data, and recommendations for individualized medication therapy because pharmacogenomic testing 

can offer patient-specific predictors for drug response. There are career paths for pharmacists in both inpatient and outpatient settings, 

including managing clinical pharmacogenomics consultation services and teaching families and patients about pharmacogenomic 

screening. Therefore, clinical pharmacists play a crucial role in improving lives through proper medical management. The pharmacy 

curriculum includes coursework that offers opportunities to gain knowledge and skills in pharmacogenomics. These opportunities also 

extend to postgraduate education (such as residencies, fellowships, and continuing education). The Clinical Pharmacy Advocacy 

Group emphasizes the need for improved training for chemists in practice as well as students to take precision medicine into account. 

This review elaborates on the scope of precision medicine, its applications, and the role of a clinical pharmacist in advocating this 

practice. 

Key words: Clinical pharmacist, precision medicine, oncology, pharmacogenomics 

he concept of "precision medicine" has gained 

popularity in recent years, owing to scientific and 

political perspectives. Despite its popularity, it is 

unclear what it means and how it differs from other popular 

concepts such as "stratified medicine," "targeted therapy," or 

"deep phenol-typing." Commonly used definitions focus on 

patient stratification, also known as a novel taxonomy, and are 

created using large-scale data sets that include clinical, 

lifestyle, genetic, and additional biomarker information, 

thereby going beyond the traditional "signs-and-symptoms" 

approach. While these points are important, the description 

raises several problems. When, for example, does precision 

medicine begin? In what ways can patient classification 

translate into improved medical care? And, as implied, is 

precision medicine the end-point of a novel classification of 

patients, or is it part of a larger whole? Furthermore, are our 

pharmacists' important members of the precision medicine 

clinical care team? [1]. 

Personalized medicine is a more traditional concept that is 

frequently used interchangeably with precision medicine. It 

aims to use therapies or prevention techniques that are specific 

to a person's disease process or symptoms [2]. Treatment 

procedures utilized a one-size-fits-all framework in which all  

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Received –  20th July 2024 

Initial Review –  13th August 2024 

Accepted – 24th August 2024 

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individuals presenting with a comparable constellation of 

symptoms received the same treatment. This practice has led 

to a reasonable desire for more exact forms of diagnosis and 

treatment, allowing patients with specific symptoms to receive 

more individualized care. In many ways, communicable 

disease management has long been congruent with precision 

medicine goals, including identifying causal organisms and 

building data warehouses to drive particular treatments for 

infections. Infectious illness management has integrated 

technology over time to acquire a better understanding of 

resistant organisms and to safeguard people [3].  

Personalized medicine then aims to incorporate technology 

with medicine to develop a data ecosystem capable of better 

identifying and treating a patient's ailment. This strategy 

intends to integrate clinical characteristics and biological 

details, from imaging to testing in laboratories (including -

omics data) and health records, in a seamless manner. The 

reasoning behind this is to create an entirely novel 

classification of human disease based on molecular biology. 

The National Council Report of 2011 has implied that this will 

lead to better diagnosis, treatment selection, and novel 

therapies [4]. Precision medicine has also had an impact on 

________________________________________________ 

Correspondence to: Janice Jacson Mandumpala, Department 

of Pharmacy Practice, Nirmala College of Pharmacy, 

Muvattupuzha, Ernakulam, Kerala, India 

Email: janice.jacson@gmail.com 

T 

mailto:janice.jacson@gmail.com


Jacson                                                                           Role of clinical pharmacists in the precision medicine landscape 

 

Online First                                                                                                                      Indian J Pharm Drug Studies | 2  

 

non-communicable disease therapy. Notionally, precision 

medicine approaches will help to inform and improve disease 

taxonomy, leading to greater specificity about the 

pathogenesis of complex conditions such as cancer, heart 

disease, and overweight and obesity, as well as a paradigm 

shift in potential therapeutic interventions that maximize 

disease treatment while minimizing adverse events [5]. 

Although many consider precision medicine to be one of the 

most exciting advancements in medicine, it has also generated 

important problems at multiple levels. Many of these concerns 

relate to what Kimmelman and Tannock refer to as the 

'paradox of precision medicine'. Interestingly, ambiguity 

appears to be a significant feature of precision medicine in 

practice [6]. With the advent of various treatment-related 

threats, it is important to identify the role of precision 

medicine in treatment practice [7]. Clinical pharmacists play 

an important role in identifying various problems within the 

treatment regimens of a patient and could be pivotal in 

implementing precision medicine strategies [8].  

With this backdrop, we must fully understand the potential 

of precision medicine and its effectiveness in treating various 

diseases using a customized approach. 

METHOD AND MATERIALS 

Precision medicine and the epigenetic landscape of various 

diseases 

The metabolic condition with the fastest-rising incidence in 

the world, type 2 diabetes mellitus, is linked to epigenetics, 

according to groundbreaking studies conducted over the past 

few decades [9]. Importantly, these investigations found 

epigenetic alterations in the pancreatic islets, adipose tissue, 

skeletal muscle, and liver of people with type 2 diabetes 

mellitus, including altered DNA methylation [10]. Since 

epigenetic changes have been linked to non-genetic factors 

that influence the risk of type 2 diabetes mellitus in healthy 

persons, including obesity, a poor diet, physical inactivity, 

aging, and the intrauterine environment, epigenetics is likely 

also a factor in the development of type 2 diabetes mellitus. 

Additionally, the epigenome in human tissues is impacted by 

genetic variables linked to type 2 diabetes mellitus and obesity 

[11]. A notable finding of causal mediation analysis was the 

identification of DNA methylation as a potential mediator of 

genetic correlations with metabolic characteristics and disease. 

Translational studies conducted in the last few years have 

found blood-based epigenetic markers that may be further 

refined and used in precision medicine to enable patients with 

type 2 diabetes mellitus to obtain the best care possible and to 

identify people at risk of problems [12].  

The etiology of lung disorders is influenced by both 

genetic predisposition and environmental risk factors. 

Epigenetic mechanisms indicate possible biological pathways 

that could close this gap [13]. There is growing evidence of 

abnormal epigenetic marks, primarily DNA methylation and 

histone modifications, which mediate reversible alterations to 

the DNA without changing the genomic sequence, in 

individuals with COPD, asthma, and pulmonary arterial 

hypertension. MicroRNAs and post-translational processes 

may have a role in the development of diseases and be 

controlled epigenetically. Thus, peripheral blood, sputum, 

nasal and buccal swabs, or lung tissue may be able to detect 

novel disease pathways and possible biomarkers [14]. 

Additionally, environmental exposures may have an impact on 

DNA methylation during the early stages of fetal 

development, which may then affect an individual's eventual 

susceptibility to COPD, asthma, and pulmonary arterial 

hypertension [15]. Modeling epigenetic variability in a 

network framework rather than as individual molecular 

abnormalities offers insights into potential molecular 

pathways underlying the pathogenesis of COPD, asthma, and 

pulmonary arterial hypertension thanks to advancements in 

omics platforms and the use of computational biology 

methods. Clinical applications for epigenetic alterations as 

non-invasive pulmonary disease indicators are possible [16]. 

To further improve the primary prevention of lung diseases 

and their subsequent clinical management, network analysis of 

epigenomic data combined with molecular tests may help to 

elucidate the multistage shift from a "pre-disease" to a 

"disease" state.  

Throughout the natural course of tumor formation, 

epigenetic abnormalities such as aberrant covalent histone 

modifications and DNA methylation deficiencies are selected 

for [17]. Changes are detectable in early initiation, 

progression, and eventually recurrence and metastasis. It is 

becoming more clinically relevant to discover these markers 

and use them to categorize patient populations at risk, improve 

diagnostic standards, and provide prognostic and predictive 

indicators to help with treatment choices [18]. A great 

potential to change therapy paradigms and offer new 

therapeutic alternatives for patients whose cancers have these 

aberrant epigenetic alterations is also presented by the 

targetable nature of epigenetic modifications, opening the door 

to novel and personalized treatments [19]. Due to its stability 

and comparatively simple testing, DNA methylation has been 

demonstrated to be quite useful in therapeutic settings. 

Therefore, both precision medicine and epigenetics go hand in 

hand while working on the treatment of cancers. 

Precision medicine and cancer treatment 

The rapidly developing amount of information regarding the 

roles of genetics and the immune system in cancer has allowed 

for the creation of medicines that target specific molecular 

abnormalities or other biologic traits, such as those involved 

in immune suppression. However, genomics has revealed a 

convoluted truth about malignancies that necessitates a 



Jacson                                                                           Role of clinical pharmacists in the precision medicine landscape 

 

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significant shift in the therapy paradigm: away from tumor-

type-centered treatment and towards gene-directed, histology-

agnostic treatment that is tailored to each patient based on 

biomarker analyses. The rise of precision medicine trials with 

creative design reflects this paradigm shift [20]. Next-

generation sequencing of advanced malignancies has revealed 

that genomic changes do not neatly fall into categories defined 

by the tumor organ of origin. Furthermore, metastatic tumors 

have extraordinarily complicated and distinct genetic and 

immunological landscapes [21]. As a result, to target cancers 

with "precision," treatment must be personalized. 

Although immunotherapy has a limited ability to treat 

ovarian cancer, it may be more effective if sensitive/resistant 

target treatment subpopulations are assessed based on tumor 

biomarker stratification. Tumor mutation burden, PD-L1, 

tumor-infiltrating cells, homologous recombination deficit, 

and neoantigen intratumoral heterogeneity are among these 

markers. The use of these biomarkers to determine suitable 

candidates is one of the next directions in the treatment of 

ovarian cancer [22]. Furthermore, precision medicine and 

targeted therapies have a long history of use in the treatment 

of breast cancer and continue to hold promise for more 

specialized and personalized care. Targeted medicines and 

precision medicine continue to push the management of breast 

cancer towards more individualized care, from the discovery 

of endocrine and HER2-targeted medications to multigene 

arrays in chemotherapy for more specific patient selection, to 

radionics and genetic subtyping [23].  

Precision medicine has emerged as a key concept in the 

treatment of biliary tract tumors (BTCs). Although the 

prognosis remains dismal, advances in molecular 

characterization, as well as the approval of numerous targeted 

medicines by the US Food and Drug Administration, have 

altered the therapeutic landscape of advanced BTC. Chronic 

inflammation of the liver and biliary tract, independent of 

anatomical subtype, is a hallmark of BTC oncogenesis [24]. 

BTC subtypes correspond to various molecular properties, 

making BTC a molecularly diverse group of tumors. Up to 

40% of BTCs have a potentially targetable molecular 

aberration, according to the National Comprehensive Cancer 

Network guidelines, and molecular profiling is recommended 

for all patients with advanced BTC [25]. The use of 

circulating tumor DNA, immunohistochemistry, and next-

generation sequencing for biomarker-driven management and 

molecular surveillance of BTC is expanding. Improving 

outcomes for non-targetable tumors utilizing biomarker-

agnostic treatment is also a focus, and combinational 

treatment techniques such as immune checkpoint blockade 

plus chemotherapy have promise for this patient group [26].  

With the development of precision medical tools, research, 

and treatments, the diagnosis and treatment of diseases such as 

cancer are getting more accurate and specialized. Diagnostic 

tests can determine particular, individual information from 

each patient and direct clinicians to a more accurate treatment 

plan by reaching down to the cellular and even sub-cellular 

level. With this increased knowledge, researchers and 

providers may better assess the efficacy of medications, 

radiation, and other therapy, resulting in a more accurate, if 

not more optimistic, prognosis. New methodologies, 

equipment, materials, and testing methods will be necessary as 

precision medicine becomes more entrenched (Figure 1). 

 

Figure 1 – Evolving precision medicine techniques for 

cancer treatment 

Ethical Issues in precision medicine 

Precision medicine bases disease treatment and prevention on 

a patient's unique gene, environmental, and lifestyle 

variations. It is a logical continuation of existing research that 

profiles and identifies therapeutically useful markers utilizing 

multi-omics-based laboratory tests. In essence, the objective is 

to gather genotypic and phenotypic data to guide precise and 

efficient patient therapy. Typically, significant and difficult 

testing would be needed before any practical clinical 

applicability to patients. Precision medicine's integration into 

healthcare will heavily rely on clinical laboratories. Reflex 

testing based on algorithms or specific case judgments is 

frequently required for laboratory work. Laboratory and 

clinical data will be integrated to provide the basis for 

interpretation [27]. The clinical laboratory must become a 

more active collaborator in clinical treatment as a result of 

both indirect and direct transmission of test data to patients.  

Large databases of research and clinical data, as well as 

numerous multi-omics-based laboratory experiments, serve as 

the foundation for both research and the emerging clinical 

practice of precision medicine. This situation may lead to 

moral conundrums involving justice, autonomy, additional 

findings, consent, and privacy. Precision medicine's 

requirements must be balanced with the idea that patients' 

interests come first, which leads to conflicts that frequently 

can go unresolved. 



Jacson                                                                           Role of clinical pharmacists in the precision medicine landscape 

 

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In precision medicine, data collection and analysis go 

further than is required to look into specific clinical conditions 

[28]. Over time, the data gathered and research objectives 

frequently change. This makes it difficult to gain informed 

consent based on proper counseling. Some of the issues might 

be resolved with flexible permission that can alter over time. 

In other circumstances, assumed consent will be regarded as 

sufficient [29].  

Data profiles can be used to identify people in anonymous 

databanks, which raises serious privacy concerns in databanks 

used for precision medicine. How can data access be restricted 

to preserve privacy without jeopardizing support for precision 

medicine, and under what circumstances should this be 

permitted? In this area, we are still in the early phases of 

determining the appropriate standards and stakeholder ratio 

[30]. Individuals must face just a small amount of information 

risk, or no appreciable additional risk, as a result of having 

their data processed in the databanks.  

Fairness without discrimination for all is the foundation of 

justice. The key concern is how to deliver the benefits and 

advancements of precision medicine while maintaining equal 

access to healthcare. Precision medicine requires significant 

clinical and research work. Given the disparities in genetic 

makeup, habitats, and lifestyles, research data are typically 

generated from wealthy communities, and results may not 

apply to other less fortunate people [31]. Clinical testing on 

individuals will be costly, even though greater precision 

medicine effectiveness may occasionally result in cost 

savings. In this context, individual rights present one 

challenging ethical conundrum [32]. Can the state mandate 

that people adopt precision healthy lives in exchange for 

providing equitable access to precision medicine? 

Precision medicine is an evolving field that raises both 

professional and patient expectations. Instead of being 

arrogant, the field should carefully manage expectations and 

avoid making promises that it cannot possibly keep. 

Where does the clinical pharmacist fit? 

Precision medicine has been used in clinical pharmacy 

practice for many years. As part of standard clinical practice, 

drug selection and dosage based on patient-specific clinical 

parameters such as age, weight, renal function, drug 

interactions, plasma drug concentrations, and nutrition are 

expected. While epigenetics and pharmacomicrobiomics are 

still mostly studied in the academic arena, clinical translation 

of these concepts into clinical practice is anticipated in the 

future. Pharmacogenomics is one of the more recent precision 

medicine concepts to be used in clinical treatment.  

The following sections elaborate on the role of pharmacists 

or clinical pharmacists in the field of precision medicine. 

Chemists must be involved in these advancements as precision 

medicine research and its clinical applications continue to 

grow to provide patients with the best, most individualized 

medication regimens. 

Adverse events in children are frequently unanticipated 

and patient response to pharmaceutical therapy is very diverse. 

Some patients might experience major side effects from 

conventional doses of a particular medication and need a 

lower dose, whilst other patients might need a significantly 

higher dose of the same medication to get a similar exposure 

and, hopefully, an analogous therapeutic response [33]. A 

clinical pharmacist’s understanding of how differences in a 

single gene, gene networks, and/or the entire genome 

(pharmacogenomics) may affect drug responsiveness has 

dramatically improved over the past two decades. The 

adoption of pharmacogenomic testing in inpatient treatment is 

also made possible by growing genetic test availability in 

clinical laboratories (including direct-to-consumer testing) and 

falling analytical costs. Therefore, the promise of precision 

medicine is gradually making its way into clinical treatment 

[34]. Pharmacogenomics now unquestionably plays a 

significant role in medication development, regulation, and 

prescription. Pharmacogenomics is proving to be a potential 

clinical tool for pharmacists who can use it to create 

individualized treatment plans for children [35]. By choosing 

the right medication at the right dosage for the right patient, 

pharmacists can lower their risk of adverse drug events and/or 

treatment failure.  

Since the original position statement's publication in 2011, 

the roles that pharmacists play in clinical pharmacogenomics 

have become more clearly defined, but there are still many 

opportunities for our profession and practice specialty to 

promote and establish the role of pediatric pharmacists in 

pharmacogenomics [36]. Pediatric pharmacists routinely 

recommend medications and dosages as members of the 

multidisciplinary team based on a variety of clinical 

considerations, such as a child's age, physiology, concurrent 

medications, and diagnosis. Knowing a patient's 

pharmacogenomic data, including the ontogeny of various 

drug-metabolizing enzymes, transporters, and receptors, 

increases the probability that a prescription will be chosen for 

the person that is both safe and effective.  This information can 

be used by the pediatric pharmacist to prevent therapeutic failures 

and proactively lower the likelihood of unwanted adverse 

medication events [37]. Based on their education and expertise, 

pediatric pharmacists with a working grasp of pharmacogenomics 

are perhaps the most appropriate members of the medical team 

to prescribe pharmacogenomic testing and to provide an 

interpretation of results in the context of a child's 

pharmacotherapy. Additionally, pediatric clinical pharmacists 

frequently participate in pharmacy and therapeutics 

committees and collaborate closely with pharmacy IT support 

[38]. In these positions, they are in a good position to suggest 



Jacson                                                                           Role of clinical pharmacists in the precision medicine landscape 

 

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gene/drug pairings for institutional use and to develop clinical 

decision support tools specifically for prescribing doctors, 

physician assistants, and nurse practitioners. 

Future Direction of Precision Medicine in 

Pharmacotherapeutics 

Precision medicine is a new method for treating and 

preventing diseases that take into account each person's 

unique genetic makeup, environmental factors, and way of 

life. This method will enable medical practitioners and 

academics to forecast treatment and preventative plans for a 

condition that a specific person is experiencing more 

precisely. This strategy will alter clinical pharmacy practice in 

several significant ways. The link between pharmacogenomics 

and pharmacodynamics, pharmacogenomics and 

pharmacokinetics, and pharmacogenomics and 

pharmacodynamics is the subject of numerous studies that are 

now being conducted. To further comprehend the uniqueness 

of therapy response, more recent studies like metabolomics 

and epigenomics are being done. This new information will be 

crucial for managing highly effective, risk-free medication in 

the future. 

CONCLUSION 

Despite several examples being developed in various fields of 

pharmacy and medicine, the application of precision medicine 

in clinical practice is still largely constrained by factors like 

cost and accessibility of assays. Precision, personalized patient 

care could become a clinical reality thanks to developments in 

the "omics" sciences and the rising accessibility of health data. 

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How to cite this article: Mandumpala JJ. PRECISION 

MEDICINE AND CLINICAL PHARMACISTS. Indian J 

Pharm Drug Studies. 2024; Online First. 

Funding: None;                 Conflicts of Interest: None Stated 

 


