IT IS time to embrace a new era of medical science in which treatments are not based on a ‘one-size-fits-all’ approach but are tailored to a person’s genetic makeup. Personalised medicine, based on pharmacogenomics, the study of the effect of genes on drug response, has the potential to transform health care in Bangladesh. The use of personalised medicine could improve treatment efficacy and reduce adverse effects, especially in the face of an increasing burden of non-communicable diseases such as diabetes, cardiovascular diseases and cancer.
The wide genetic diversity in Bangladesh significantly affects drug metabolism patterns, which in turn influences how treatments work in patients. Scientists estimate that between 30 and 50 per cent of Bangladeshi patients experience adverse drug reactions resulting from genetic variances. Current standard treatments for cancer, hypertension and diabetes do not take genetic differences into account, resulting in suboptimal patient outcomes. At Bangladesh Medical University, formerly Bangabandhu Sheikh Mujib Medical University, a recent study tested the genetic profiles of 200 breast cancer patients and found that almost 40 per cent carried the HER2-positive mutation. The administration of trastuzumab (Herceptin) showed positive results in HER2-positive patients, with better outcomes than traditional chemotherapy methods.
Pharmacogenomics has also demonstrated important effects in the management of cardiovascular diseases. Results from the Dhaka University Journal of Pharmaceutical Sciences showed that genetic differences in the drug-metabolising enzymes CYP2C19 and CYP3A4 affect how the body processes clopidogrel and statin medications. Records from the International Centre for Diarrhoeal Disease Research, Bangladesh, showed that variations in the SLCO1B1 gene triggered severe muscle toxicity during statin administration in 15 per cent of patients. Testing for these genetic markers during medical prescription offers a way to prevent unwanted side effects and improve treatment effectiveness.
In addition to its role in disease management, personalised medicine has proven effective in combating antibiotic resistance. Antibiotic resistance stems primarily from the excessive and improper use of antibiotics. The Bangladesh Journal of Medical Science demonstrated that antibiotic treatment outcomes improve when drugs are prescribed based on a patient’s genetic makeup, particularly in the management of tuberculosis. Through this approach, healthcare professionals could achieve lower rates of antibiotic resistance while enhancing patient recovery.
However, personalised medicine continues to face specific challenges within the Bangladeshi healthcare environment. The main obstacle is the limited availability of genetic testing. Genetic screening services are offered at the Bangladesh Medical Unviersity and the International Centre for Diarrhoeal Disease Research, Bangladesh, yet most patients cannot afford testing due to the limited capacity of these facilities. Genetic testing currently costs between Tk 15,000 and 50,000 — an amount unaffordable to most Bangladeshis. Moreover, there is no insurance policy in place to cover genetic testing, even though the United Kingdom includes pharmacogenomics within its National Health Service coverage.
Low levels of education and limited awareness of pharmacogenomics among healthcare providers also present major barriers. A survey published on Academia.edu revealed that while 85 per cent of Bangladeshi healthcare professionals recognise the value of pharmacogenomics, only 30 per cent have received education in the field. Many doctors do not adopt genetic testing in patient care due to a lack of suitable training, which hampers the integration of personalised medicine into standard medical practice. Furthermore, the absence of a national policy on genetic data privacy and ethical considerations complicates the implementation of such technologies.
These national challenges call for Bangladesh to invest in expanding genetic research and to develop a national pharmacogenomics database. Identifying shared genetic indicators among Bangladeshis would facilitate the development of more effective local drug therapies. Public and governmental funding to develop genetic testing infrastructure would lower costs and increase the availability of testing services. Including pharmacogenomics in the medical curriculum for students and healthcare professionals would provide the necessary expertise to deliver personalised care.
Successful personalised medicine programmes around the world can serve as models for Bangladesh. India’s IndiGen Project mapped the genetic diversity of 1,000 individuals, enhancing its pharmacogenomic capabilities. The All of Us Research Programme in the United States gathers genome data from diverse ethnic populations to support pharmaceutical development. The NHS Genomic Medicine Service of the United Kingdom has incorporated pharmacogenomic screening into routine clinical care, leading to a significant reduction in adverse drug reactions. A model like this could help Bangladesh formulate healthcare-focused pharmacogenomics strategies.
Although launching personalised medicine in Bangladesh will not be easy, the potential benefits for patients and society make it a worthwhile pursuit. Personalised medicine represents a new era in Bangladeshi health care — one with fewer adverse drug reactions, more successful treatments and lower overall healthcare costs in the long term. While limitations remain—particularly in terms of resources, cost and awareness — prudent investment in genetic research, education and infrastructure can enable the successful implementation of personalised medicine, ultimately improving the quality of life for millions.
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Md Abu Sayed studies pharmacy at the World University of Bangladesh.
