703high genetic risk and better quantifi cation of risk in family members. Greatest
progress will be made in understanding the genetic contribution to the intermediate
phenotypes linking genes and disease, and thus the biology of the disorder, as in
atherosclerotic disease. The greatest impact of personalized medicine will be in the
treatment of cancer, cardiovascular diseases, infections and neurological disorders.
The emerging fi elds of metabonomics (metabolite profi ling to identify genotype-
phenotype associations) and phenomics might offer solutions for anticipating and
decreasing risk of adverse drug reactions in each individual patient, but tests based
on these approaches are not expected to become generally available to the practicing
clinician for at least the next 5 years.
Genetic Testing and Concerns About Equality of Healthcare
There is a concern genomics and associated technologies may exacerbate dispari-
ties at multiple levels because of unequal application among human populations.
Unequal treatment of minority patients in the US has been attributed to many fac-
tors including poverty, racism, unequal access to health care, and increased costs
that are likely to be associated with genetic tests and procedures. How this will
change if universal health care is implemented remains to be seen. Genomic tech-
nologies will provide new opportunities and their translation into healthcare appli-
cations should not be held back because of this concern. Genetic data collection
should be extended to as many diverse populations as possible. It is also critical to
assess nongenetic factors, which vary substantially among populations and may
interact in important ways with genetic risk factors. Analyses of these effects and
interactions can be especially powerful in the context of large, long-term prospec-
tive studies. To make the best use of genomic data, physicians and the public should
be educated about its benefi ts as well as limitations. Such measures may help to
reduce disparities in health.
Pharmacotyping
Pharmacotyping is individualized drug selection and dosage profi ling by the phy-
sician based on clinical evaluation of the patient’s genotyping and haplotyping
data for genes involved in the pharmacokinetics and pharmacodynamics of drugs
in the body (Vizirianakis 2007 ). Pharmacotyping could be a new dimension of
pharmacogenetics/pharmacogenomics and its application in routine clinical prac-
tice in the post-genomic era could better depict drug selection and dosage. This
means a transition from a drug-selection process mainly based on the physician’s
own experience, into a more, highly integrated, information-based and computer-
aided pharmacotherapy-based decision, thus making drug delivery digitized, more
effi cient and safer. Advances in in silico modeling for predicting ADME
Opportunities and Challenges of Personalized Medicine