Introductionassessing The Potential Impact Of Pharmacogenetics

Trying to assess the social, ethical, legal, and practice issues raised by a medical innovation is not easy, as great uncertainty often surrounds the technology, how it might be used in the clinic, and the responses of patients, professionals, and the public. Despite the difficulties of trying to achieve a meaningful and realistic appraisal, it is a vitally important task. If controversial new technologies are introduced into the clinic without careful consideration of the issues they raise and if appropriate governance mechanisms are not put in place in response, there is a real danger that public acceptance will be low, resulting in poor uptake and a loss of trust in the integrity of the profession.

Pharmacogenetics is at a very early stage of development, with few working examples established in routine clinical practice. The analysis presented here will therefore look at a series of possibilities or "options" for the application of the technology and explore the potential social, ethical, and legal problems that might be realistically associated with them. This list of options is not hypothetical but has been drawn up on the basis of detailed research on the commercial and clinical development of pharmaco-genetic technology. It therefore represents the applications most likely to become a reality. However, it must be stressed that some applications may never be translated into practice, because they are contingent on technical feasibility, proven clinical utility, and commercial success. As a consequence, a number of the social and ethical problems that we described may remain only as possibilities.

This chapter starts with a brief outline of some of the well-established principles used to assess the ethics of medical research and practice. It sets out the limitations to an approach based purely on "principlism." The most realistic options for the development of pharmacogenetics technology will then be described. This will be followed by a discussion of the main social, ethical, and legal issues that are raised. In conclusion, we highlight the key points to have arisen from this analysis and suggest how public policy might provide an effective governance framework for this important new technology.

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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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