Potential Costs and Benefits of Pharmacogenomics
Potential Costs and Benefits of Pharmacogenomics
Precision vs. Trial & Error: Your Genome Can Potentially Save Your Life…But at What Cost?
By Rebecca Del Rio
When your father almost passes away, you start to think of all the what-if questions. What if the doctors made or make a mistake? What if his medication is too strong or not potent enough? What would happen if I lost him? Now imagine you could answer some of these questions with one simple test.
Pharmacogenomics is the use of one’s genetic information, or genome, to assist in the decision making process of choosing the proper drug type and dosage that will allow for the body to have the best possible response. With the isolation of specific genes among the thousands, doctors have the capability to embrace “precision” methods to ensure that patients have a greater chance of receiving a better pharmaceutical treatment, as long as it remains within the limits of the testing. In this paper, the ethical values of safety, fairness and autonomy will be explored in relation to the method of pharmacogenomics and if it were to be implemented in the United States as a possible standard of care technique. Ultimately, the goal of this paper is to analyze and deduce an answer to the main ethical focus question: Should all citizens of the United States have their genome sequenced as a requirement for medical records?, while pondering whether pharmacogenomics will become an accepted form of standard testing in future society.
You decide your medical future and remember, your life may depend on the choices you make. Now you must decide: do you want the help?
Table of Contents
- What is Pharmacogenomics?
- Ethical Focus
- Should the Genome be Sequenced at All?
- Would this Method Become a Public Health Measure by Becoming a form of Standard Care?
- When and Where Should an Individual’s Genome be Sequenced?
On January 27, 2014, my father was rushed to the hospital from work due to him having a heart attack prior to leaving his office. At the hospital, my father needed to have major surgery, including the placing in of a stent, because of the severity of the situation. Once surgery was completed, the doctor prescribed my father warfarin, a blood thinning medication that prevents blood clots from potentially forming within the main arteries as a rejection to the newly added stent. Although my father’s situation seems as if doctors did everything they could, which they did, a potential complication could have arose when my father needed emergency gallbladder surgery. The surgery had great risk—each risk taken, my father faced the possibility of death. With warfarin being a blood thinner, a dosage that is too much for the body to handle could cause the risk of bleeding out; the body does not have the ability to clot blood to close open wounds. In addition, with a dosage that is too little for the body, the risk faced would be the medication having no effect, leading blood to clot and the heart stopping to function. My father went through with the surgery—he had no choice. A week prior, the doctors decided to reduce the dosage of his warfarin as preparation for the surgery. I would like now to say that my father is doing well and all the procedures were successful yet now looking back on the situation, I have developed some “concern” regarding the choices the doctors made in relation to my father’s condition. I assume that some of you may wonder, “What concerns could you have? Everything went well? Isn’t that good enough?” In this case, yes it was, but others are not as fortunate as my father was. As this paper develops, the “concern” will become more prevalent and clear.
This paper will highlight the ethical implications that continue to influence discussion regarding whether there is true necessity behind screening for genetic variants to simply modify medications. While examining my main focus question: Should all citizens of the United States have their genome sequenced as a requirement for medical records, the method of pharmacogenomics will be used to analyze this question.
What is Pharmacogenomics?
A possible method that could have been used to ease the “concern” in the case of my father is pharmacogenomics, which is also known as precision medicine. Pharmacogenomics is the use of the information obtained regarding a person’s genetic makeup, or genome, through genome sequencing or targeted genetic testing to choose the type of drug and dosage that will allow for the body to have the best possible response. This method is a combination of pharmacology, which is the study of the uses and effects of medications, and genomics, the study of genes and their functions. The purpose of pharmacogenomics is to look for changes in gene variants that determine whether medication will be effective for the specific patient, the correct dosages for that patient, and whether side effects are possible. This provided information is combined with the additional knowledge of age, lifestyle, other medications being taken and overall health to draw conclusions. For example, in the case of my father, specific gene variants associated with bleeding would be looked for through genome sequencing or targeted genetic testing, and that data, along with his personal medical history, would be used to determine the proper type and dosage of medication that should be prescribed to him. Furthermore, pharmacogenomics consists of genome sequencing or pharmacogenomic tests, both only needing to be completed once due to one’s genetic makeup not changing over time. Yet it is important to note that one pharmacogenomic test cannot provide assistance and insight on all designated medications; each medication has its own test that must be completed if the genome is not already sequenced. In addition, besides genetic makeup never changing, these tests or sequencing never have to be repeated due to labs and healthcare providers being able to store the information into online databases. One of the only reasons that a test would need to be repeated is if data is lost due to a crashing of the database. To use the method of pharmacogenomics, the entire genome does not need to be sequenced, unless the genome is wanted for future reference for when new research is conducted that identifies more genetic variants that have a relationship to how a patient responds to a drug. In the case of my father, he could have had his full genome sequenced to be placed in his medical records, allowing his physicians to have access to this data in the future, or completed one targeted genetic test specific to warfarin dosing.
One way to approach the method of pharmacogenomics is for an individual to have their genome sequenced to determine the order of nucleotides, which are adenine, guanine, cytosine and thymine, in DNA by using high-technological machinery. By conducting this sequencing, one’s genome is possessed for physicians to use as a guide when prescribing medications. An individual’s genome is important because it provides hereditary instruction for maintaining life and passing on important information to the next generation. Humans are diploid organisms, meaning they contain duplicate, but not identical, copies of almost their entire DNA consolidated into pairs of chromosomes, one chromosome being inherited from each parent. For diploid organisms, the entire genome consists of 6 million nitrogenous bases. To begin the whole-genome sequencing process, DNA must be cut down into smaller fragments due to there currently being no technology that can sequence the entire genome in a single step. Each smaller piece of DNA is subjected to chemical reactions that allow the identity and order of its bases to be determined; each small, sequenced piece is referred to as sequence read. The resulting set of sequence reads is assembled back together to deduce the sequence of the genome. With the aid of reference sequences of the human genome from worldwide experiments, scientists can check that the sequence reads were placed in the correct order. Although, as described, the whole genome can be sequenced, there is another process, the whole-exome sequencing process. Whole-exome sequencing is targeted sequencing of protein-coding regions in exons, or DNA segments, that are approximately 1.5% of the total human genome. With this type of genome sequencing, extra laboratory manipulations are required. The resulting genomes of both types of sequencing are referred to as draft sequences. The majority of the human genome sequences that are produced today may have gaps of information missing and may not be the most accurate because this process is fairly new. Also, nothing is perfect and high-quality due to finished sequences being very labor intensive, leading prices to rise immensely (Genome News Network).
Another available option is to complete a pharmacogenomic test, or targeted genetic test, to determine how one will respond to a specific medication. Physicians examine the targeted genes and have the knowledge to interpret the meaning of specific markers on those genes. To be more specific, the genes that are targeted are those associated with the cytochrome p450 system, which is the liver-based metabolic system in the body. The cytochrome p450 system is regulated by genes that are responsible for specific enzyme expression, meaning that enzyme production of each type of enzyme is regulated through an on-off system. These genes are specifically targeted due to enzymes being metabolizers for the breakdown of medications in the body. To determine the behavior of enzyme output, which varies among all genes, the nucleotides of each gene are analyzed. There are four types of enzyme production: extensive, intermediate, poor, and ultrarapid. Extensive enzyme output refers to the normal amount of enzyme production and expression, while intermediate enzyme output refers to a little less than normal. At the extremes, there are poor and ultrarapid enzyme output. Poor enzyme output refers to there being very little amounts of enzymes being produced and expressed, while ultrarapid refers to there being very high amounts of enzymes being produced and expressed. Although the ideal is to have extensive or intermediate enzyme production and expression, some genes do have markers that reveal that they are poor or ultrarapid enzyme producers or metabolizers. These genes indicate that a patient may face medical risks.
Drugs are designed to enter the body, begin working, and then be cleaned out. With poor metabolizers, drugs that enter the body will not be cleaned out fast enough due to enzymes failing to work or there being too little amounts of them. With the failure of the enzymes, severe side effects may arise or be intensified in a patient, an individual may accidentally overdose, or in the worst case scenario, a patient may die. With ultrarapid metabolizers, drugs do not have time to assist the body because they are cleaned out too quickly. With these metabolizers, symptoms may be intensified and more severe and death could occur. This information provides assistance to physicians to determine the proper initial dosage of a specific drug. Although these pharmacogenomic tests provide important insight to doctors, there are limitations that still remain regarding pharmacogenomic testing. When performing a pharmacogenomic test, one test cannot determine how one will respond to all medications, due to each test isolating a specific gene among the large genome. In addition, tests are not available for all medications, including commonly used aspirins and over-the-counter pain relievers.
Now that factual background knowledge has been stated, this paper will explore the reasons that cause pharmacogenomics to be both controversial and not issued as a standard use of practice in the medical field. In addition, the disparities that may arise if the method is issued as a part of standard care in the United States in the future will be analyzed. The focus will heavily be placed upon the ethical values of safety and fairness. Furthermore, this paper will provide details and perspective regarding genome sequencing as a whole. The targeted genetic test that assists in warfarin dosing will be mentioned occasionally to provide specificity and clarity.
Should the Genome be Sequenced at All?
When using genome sequencing to assist in pharmacogenomics, whole genome sequencing could be used instead of targeting genetic testing because it provides information about the entire genome, thus more genetic testing will usually not be required. However, when considering applying whole genome sequencing as a standard of care, the idea suggests potential conflict against the relative “norm” regarding individuals having the constitutional right to make medical decisions for themselves. Although pharmacogenomics would only be implemented as a suggested method, societal pressure to embrace “normal” procedures, if pharmacogenomics was to be viewed as one, would instigate internal conflicts within individuals of whether or not to embrace the opportunity. For example, this situation can be compared to society’s acceptance of western course of treatment and hesitation towards other techniques. To be more specific, one “norm” in the United States is to use prescription drugs rather than natural, herbal medications due to the mentality that prescription drugs result in better treatment and success rates. Although this may be true for some medications, this idea cannot be applied to all forms of treatments. A study was conducted in 2012 where researchers compared the benefits of curcumin in turmeric to arthritis drugs (diclofenac sodium) on rheumatoid arthritis patients. After the volunteers were split into three groups: curcumin treatment alone, diclofenac sodium alone and a combination of the two, the results revealed that the curcumin group showed the highest percentage of improvement overall and were significantly better than the patients in the diclofenac sodium group. More importantly, curcumin treatment was found to be both safe and have less risk of severe side effects, such as leaky gut and heart disease (Dr. Axe). Even with the evidence from this study and multiple studies that have been conducted across the nation, the mentality of American individuals is clouded by the pressure to conform to the normality of seeking prescription drug treatment. In relation to pharmacogenomics, the societal viewpoint regarding the topic will determine the success it has as a standard form of practice in the medical field.
So what would be the potential pros and cons of making whole genome sequencing a standard of care? An argument, regarding the safety of a patient, can be made that there could be the possibility of less health risk and side effects if sequencing is completed. By conducting sequences, physicians are able to identify medications and dosages that will have the most positive effect. With this, one can further argue that there is minimal risk to the body when sequencing is conducted due to one’s genes not being altered, but rather “read”. As a counter-argument, an individual can state that many do not face great risk when prescribed medications the “normal” way and that tests are not always definite, which is actually true. There are cases where the sequencing and pharmacogenomic tests have not been useful to doctors because they only provide clues rather than actual numbers in relation to dosage. For example, in 2013, the National Institutes of Health (NIH) conducted an experiment to determine if genomic testing improved warfarin dosing. Researchers conducted a large clinical trial where patients were randomly assigned to receive warfarin doses for 5 days of therapy based on their clinical and genetic characteristics. The results revealed that “blooding thinning was within the desired range 45% of the time in both groups during the 28-day monitoring period, based on standardized blood clotting tests. Adding genetic information to the dosing formula did not improve clotting control” (NIH Researchers). With such information being available on the internet, this potentially can lead many to believe that genome sequencing is solely an invasion of privacy that is unnecessary.
But what about the thousands of individuals who pass away each year due to problems or allergic reactions to medications. Here arises an issue regarding whether all individuals should be forced to have their genome sequenced or a choice can be made for each individual. This concept becomes even more complicated when deciding what autonomy minors have regarding their medical decisions in relation to pharmacogenomics. Although this paper will not explore in detail the concept of autonomy of all individuals, especially minors, one cannot deny that this is another question that would have to be considered before any actions are taken to implement this method. In addition, in relation to autonomy, doctors are usually those who determine if sequencing is necessary. This leaves a patient with two options: trust in their doctor that they live by the code of nonmaleficence to do no harm or obtain a second opinion to avoid jeopardizing their own life. Doctors recite the Hippocratic Oath as a form of dedication to fulfilling the best of their ability by their own judgment with each patient that calls for their care. With this oath, doctors reveal that they have the proper knowledge and compassion towards patients to ensure that they are not only in proper care, but more specifically, are provided the right medications. In the case of my father, I have come to understand that it is possible that my father’s doctors did not order sequencing or genetic testing to help make a drug and dosage decision because they did not think the genetic information added any value to what the physician already knew about my father’s medical condition. In contrast with this idealistic mentality, no one can deny that no individual is perfect and mistakes can be made at any point. Rather than taking the risk or constantly obtaining second opinions, pharmacogenomics may seem to be the clear answer to some individuals.
In relation to the safety of information, another perspective of safety can be pondered to help unpackage the complexity of the question posed. An individual may argue that although one’s entire genome is sequenced, only isolated genes and results are being focused upon by physicians. Yet, is it necessary for the entire genome to be sequenced or just fragments of the code? What should be included in medical records: all information the genome tells or just pharmacogenomic test results? The answer to this question may depend on the individual patient or the doctor. The genome provides important information, more than just the efficiency and metabolization rate of specific drugs. The genome indicates possibilities of having diseases or allergies, and this information helps doctors to choose the best medications for a patient to try to ensure that the body does not react negatively.
Even though this information may help a doctor, it is not a necessity in the eyes of some individuals who are either comfortable with the skills of doctors, are not comfortable with the storing of their information in laboratory databases, or do not want to know about other medical aspects regarding their own lives. Hypothetical situations can be created that analyze whether or not individuals in the laboratory—those who analyze patients’ genomic information—have the capability to restrain themselves from alerting doctors if they see something that may be of “danger” or harm. This compromises an individual’s right not to know any information regarding their own body and an individual’s right to personal privacy. In addition, another hypothetical situation can be created if laboratory data was the target of a cyber attack. Currently, the United States’ Department of Defense (DoD) abides by its Cyber Strategy that consists of five pillars that summarize the mission of DoD in preparation for cyber attacks. These five pillars are:
- Build and maintain ready forces and capabilities to conduct cyberspace operations;
- Defend the DoD information network, secure DoD data, and mitigate risks to DoD missions;
- Be prepared to defend the U.S. homeland and U.S. vital interests from disruptive or destructive cyber attacks of significant consequence;
- Build and maintain viable cyber options and plan to use those options to control escalation and to shape the conflict environment at all stages;
- Build and maintain robust international alliances and partnerships to deter shared threats and increase international security and stability. (The Department of Defense)
Yet, with all this security, which is consistent with our allied nations, a cyber attack is still possible. For instance, on May 13, 2017 in the United Kingdom, 37 hospitals were revealed to have been ordered to shut down their systems as a precaution from a cyber attack that was targeting National Health Service (NHS) sites. The individuals behind the cyber attack threatened hospitals to pay ransom for patients files which they encrypted, further threatening that all files would be deleted after seven days (Kettley and O’Brien). With this possibility becoming a reality, it is clear that a cyber attack can occur in any nation across the world, potentially compromising the security of patient information in online databases. Additionally, just this year, some databases in the United States were hacked by Russia, meaning they had access to the information in those databases. To establish an extreme case scenario, imagine what if genomic-related information of the President of the United States was obtained by a foreign country? This could cause great havoc and lead to dangerous attempts on the President’s life. Now imagine if that was your information in their hands, would you be able to not think about it? Paranoia is a habit that can cause its own havoc on the well-being of an individual. This leads to further questioning of if the government should take the risk of providing its citizens a means to question and criticize governmental policies and intentions. Instability could lead to a downfall of a nation, yet this speculation can be currently thrown out of proportion. In reality, the response of citizens cannot be defined without experimentation, leading to potential further complication of answering the question without personal bias.
Although an individual may be able to answer any of the questions above based upon their personal beliefs and opinions, there will always be someone on the opposite side who embraces a different perspective. In reality, as will be seen throughout this entire paper, there is no wrong answer to any of the questions be analyzed; there are only different perspectives and conclusions that can be made based upon the facts.
Would this Method Become a Public Health Measure by Becoming a form of Standard Care?
When considering whether whole genome sequencing should be the standard of care to facilitate pharmacogenomics and precision medicine, insurance companies would need to pay for some or all of the costs, since many patients will not be able to afford the cost. Even if patients only get targeted testing for purposes of pharmacogenomics, most will want insurers to pay for all or some of the cost. At this time, only few insurance companies pay for whole genome sequencing or targeted genetic tests for pharmacogenomics purposes because they do not think the information from such tests is necessary to make dosing decisions. According to Joanna Armstrong, a senior medical director of Aetna, for pharmacogenomic methods to be covered by insurances:
the services must be related to the prevention, diagnosis or treatment of an illness. The information that you get from the covered service has to affect the course of treatment; the care or treatment should be likely to improve the outcome, and that improvement should be attainable outside investigational settings—meaning it’s not just a research project, but in broad clinical practice you can see improvements; and finally, the service has to be consistent with the plan design, meaning that the customers who are buying the insurance have to have included this in their plan. (GeneWatch)
When taking the course to implement this method into a form of standard care, the decision would have to be made whether the effort and resources should be placed into obtaining insurance coverage or used to maintain the current status of pharmacogenomics.
Currently, genome sequencing alone can cost $1000-$4000 dollars while targeted pharmacogenomic tests usually range from $250-$500 dollars (National Human Genome Research Institute). With this knowledge, it is clear to see that people who are economically comfortable are able to afford to have sequencing and tests undergone. This creates a disparity between the rich and the poor, ultimately emphasizing a tension regarding whose lives are valued more. Some may argue that pharmacogenomics should not be implemented as a standard of care unless all have equal access, yet is it fair to deny those who are able to engage with the opportunity the ability to do so. Possibly it is important to analyze the ethical principle of utilitarianism, which creates its own issue because how do you identify which side has the greater number of those who benefit. Is it the poor who will establish fairness with those who are rich or is it the rich who may be able to save lives with this method of prescribing medicine? As mentioned prior, if pharmacogenomics became a covered standard of care, the disparity would not disappear due to people of lower classes and statuses possibly not having the proper insurance plan or coverage that allows these methods to be used. Overall, the problem of which side is to be valued more still remains.
A medical procedure that can be viewed in a similar manner is the process of plastic surgery. Plastic surgery, for cosmetic reasons, is not covered by insurances due to the procedure being viewed as a luxury rather than a necessity. By insurances not covering these surgeries, an audience is able to see the development of a similar disparity between the rich and the poor. In both these scenarios, the rich have the greater advantage of obtaining these opportunities to benefit their lives. The difference between the method of pharmacogenomics and plastic surgery is that insurances will cover plastic surgery procedures if they are considered reconstructive and non-cosmetic. For example, when my mother was in her car accident, she required reconstructive surgery on her nose. Although this process is plastic surgery, our insurance covered the entire procedure. If pharmacogenomics was to adopt a similar process, although it will not be exactly the same, insurance companies could cover genome sequencing for all individuals and leave targeted genetic tests uncovered. Although this still leaves disparity between the rich and the poor, the costs of pharmacogenomic tests are significantly cheaper. The problem in relation to financial access is not solved entirely, but genome sequencing coverage could be an initial step before all procedures could be covered. Many argue this idea should be considered due to pharmacogenomics having the potential to provide valuable information that can help save or better the life of an individual, unlike cosmetic plastic surgery.
When and Where Should an Individual’s Genome be Sequenced?
Before diving deeper into the dilemma of whether a patient is to decline to conduct genome sequencing, it is important to establish primarily when the sequencing would take place in an individual’s life. Since this paper focuses on the sequencing of current adults, the most plausible answer will be introduced in the conclusion. Now in relation to adult patients, each individual currently has the right to decline to undergo the sequencing process. As mentioned before, not all individuals are comfortable with the idea of allowing others to have and be able to read their genetic makeup. This again highlights the issue of whether it is right to forcibly issue a patient to undergo such sequencing. By understanding this mentality of some patients, the answer to the overall focus question is no clearer due to not all individuals being pleased with the same things.
In addition to when a genome is sequenced, it is important to contemplate where genome sequencing will occur. Although it is important to note that underdeveloped countries around the world do not have access to facilities and proper health care systems to implement pharmacogenomics, this paper will solely focus on the United States. Even though the United States is a developed country, the health systems, hospitals and labs are not equal across the nation. Hospitals with low economic facilities may not be able to afford to perform these processes in comparison to larger hospitals that have the resources to do so. When thinking of this concept, compare the facilities between rural and urban New York. Large, urban hospitals in New York are considered first adopters, meaning it has the resources to try and currently have systems in place to do whole-genome sequencing. In addition, they have both databases to store all information and access to experts to decode the results obtained. Small hospitals in rural New York may not offer sequencing to everyone because they do not have the kind of money that larger hospitals have to pay for sequencing and data infrastructures to analyze and hold data. By realizing these identifiable disparities—ones that are consistent between facilities of each state in our nation—a decision would have to be made whether or not to mandate that all facilities be forced to obtain the resources to perform sequencing. This would most likely lead to the injury of the economy. In addition, it is important to realize that the citizens of both sides: those who have access to first adopter hospitals and those who do not will feel tension between themselves if one group is valued greater than the other; potential conflict and revolt within our nation may arise because of this tension.
A comparison of the same disparity can be applied when an audience thinks of cancer treatment centers in the United States. The best, and sometimes only, treatment centers in each state, if there are ones, are found in the major cities of each state. For example, the best treatment centers in Massachusetts and Pennsylvania are found in Boston and Philadelphia, one of the most popular cities in each state. When considering the distances needed to travel, especially in larger states, many individuals may not be able to go on the journey due to health and financial limitations. Although not all cities provide necessary treatment centers, facilities still exist across the nation to provide benefit to those individuals who can receive it. In relation to pharmacogenomics, facilities that have access to proper resources should have the ability to use those resources because pharmacogenomics can benefit all people rather than, in this scenario, just individuals who have cancer. Overall, many believe there should be a greater effort to allow all to have access to the method, especially through financial support.
In conclusion, I would argue that whole genome sequencing for the purpose of pharmacogenomics should be implemented as a standard of care in the United States. Even though I cannot definitively state that genome sequencing should be conducted on infants, due to me not exploring the ethical implications surrounding the sequencing of a child, I do believe that infant sequencing has the most potential. Infant sequencing would provide not only an orderly system but also allow doctors to have accessibility to genomic information at any given point in an individual’s life. This solution is further acceptable, due to, as mentioned before, an individual’s DNA not changing over time. Although this answer may seem clear-cut, further research must be conducted to determine the actions taken regarding those who are already born who may or may not be interested in genomic sequencing and parents who are against this procedure being conducted on their child(ren).
Furthermore, I do believe that genomic sequencing should be available to all individuals through coverage by insurance. Although this would take a large amount of effort to create policies to implement and enforce the system within insurance companies, there could be great benefit for all those involved. Insurance companies can obtain a large profit for permitting insurance plans to cover such costs and individuals have access to the opportunity to obtain insight to better their approach to receiving medication. In addition, the economy may benefit from the implementation of pharmacogenomics due to money not being wasted on what would be considered “trial and error drugs”. With such change, educational lessons and programs for pharmacists and doctors would also be needed to reinforce not only how to understand results obtained, but also provide information to parents and other adults to reveal the benefits that can be experienced if pharmacogenomics was to be set into action. Finally, death rates in relation to dosage problems and allergic reactions to incorrect medications would decrease due to the medication having a greater chance of being both the right type and dosage for each specific patient.
As technology and information advances, I believe that, in the future, the method would be evolved to include more medications, especially those that are more common. By evolving the method, physicians will be able to determine the demands for different medications, influencing pharmaceutical companies to make more of the medications that are in greater demands. With the connection between patients and these companies being established, the government would have to create regulations on the information accessed by these companies from labs and the contact these companies have with individual patients, if any at all. Also, progressing on the idea of evolution, current medications are being adapted while new medications are being created. With so much information, a possible way to manage all these details, along with allowing patients to see their medical records in relation to their genome, would be to create an online portal where each patient has a login that allows them to access this information. There should be a way to put on notifications to allow a patient to be notified when there is new or updated information being released regarding medications that they are currently taking. This way, patients remain informed about their current medical condition in an efficient manner.
To continue, after identifying the Department of Defense’s Cyber Strategy, I do not believe there is further precaution that can be taken regarding the protection of patient information. Each day, hackers create and evolve previous techniques to create their own signatures and methods of conducting cyber attacks. Without having the capability to hack into all individuals computers and laptops across the globe, due to it being illegal, hackers have the advantage over security systems, even the most advanced in the world, because there is a possibility that their code has never previously been seen. With the Department of Defense’s security being one of the most advanced systems that are constantly updated, the citizens of our nation should not dwell on the fear that a cyber attack will affect them personally.
Overall, I do not believe that patients should be required to undergo the procedure of genome sequencing yet it should be available easily to those who are interested. Even if there is still disagreement in the medical community about the value of genomic information to guide medical decisions, some genomic information will eventually be shown to be valuable. This will lead to the potential establishment of pharmacogenomics and genome sequencing as a medical “norm” in our society. Although this may be the case, one cannot deny the question that must be later explored if pharmacogenomics were to be adopted into standard medical practice: would it be better for everyone to have their whole genome sequenced or to have targeted genetic testing, the other option for pharmacogenomics, at specific points of time in their life?