Role of genetics in the personalized medicine of the SNS
Adrián Llerena, president of the SEFF and member of the SNS genetic portfolio commission.
The Ministry of Health and the autonomous communities have allocated various financial allocations to the development of knowledge and implementation of genetics to advance in the personalized medicine. These projects are moving all at the same time together with the definition of the training for health workers and the population. Some progress that, according to Adrián Llerena, president of the Spanish Society of Pharmacogenetics and Pharmacogenomics (SEFF) and member of the commission that is designing the genetic portfolio, could place Spain before the summer of 2023 What “international leader” or, on the contrary, see her plunged into a “absolute chaos”. it dit will dependaccording to the expert, of the “coordination effort” carried out by the communities and Health.
“Technically, I think that by the end of spring or beginning of summer we will have finished all the works. We can be in one exceptional situation or in the middle of a chaos with a hundred thousand things open. This will depend on a good coordination between the regional Health Services and Health. A coordination effort must be made from the Inter-territorial Council of the National Health System and the portfolio of services of the Ministry”, points out Llerena, who considers that behind the economic endowment “there is a fantastic opportunity”. “If this works well in the year 2023 Spain can lead globally From a public service point of view, the implementation of pharmacogenetics and personalized medicine”, predicts the specialist.
The also professor of Clinical Pharmacology, believes that if all the steps already started were taken correctly, Spain would be an international example in “translation of genetics to clinical use”. “This is taking the data generated under research protocol conditions and to the care practice in the real world, where the drug is exposed to other related elements such as polytherapy. From the point of view of a high population system, we were talking about a minimum and basic portfolio for 45 million people. Being done an impressive bet that the population is not getting it,” says the specialist.
In this sense, Llerena warns that right now they are happening “several processes in parallel”: “It is generated knowledge and establishment of a portfolio of services, and is being addressed training of physicians and clinical implementation. The melon has suddenly opened, so we are in a situation that if it fits, before the summer we are going to find ourselves in the perfect storm and we will be the best healthcare system in the world. We can also find ourselves in a chaotic situation if a coordination exercise is not carried out”.
Why should a coordination effort be made?
For Llerena, there is a risk that there will be autonomous communities that offer sequencing of “everything they can think of” and others that have “four biomarkers”, in addition, these will be outsourced because they will not have capacity. “If there is no adequate coordination, which is not about centralization, we can find ourselves with an absolute sub-implementation that would give rise to inequity. We must make an effort to generate information on the projects, the adequacy of the services provided by the Impact project, the recommendations of the service portfolio and now the money that reaches the autonomous communities to generate these services”, clarifies the specialist .
“A huge coordination effort is needed between the autonomous communities and the Ministry of Health”
For all these reasons, Llerena recalls that “a huge coordination effort is needed.” In addition, the result of this coordination will be Uniform mandates for all of Spain where it is indicated how to act: “We must make an effort to generate information on Biofram projects, the adequacy of the services provided by Impact, the recommendations of the service portfolio and the money that now reaches the communities to generate the service”.
Training for toilets
The training of toilets is one of the legs that has yet to be defined and this is “very worrying”, since there is a risk that in the absence of unification “several different formations” will emerge. “The health professional has to know what we have to do, who should do it and how to use it. In addition, the population must be informed, which is who is demanding the resource. They are going to say, you are going to put me on this antineoplastic cycle for this cancer according to my profile that we have selected ”, claims the specialist.
“The health professional has to know what we have to do, who has to do it and how to use genetics”
For the president of the SEFF, result “fundamental” to establish the minimum training competencies for the use of genetic biomarkers, arrival of patients and the change to a “prescription agreed with an informed patient”. To integrate all of this and avoid the emergence of several different formations, Llera is committed to making a “module or program of basic skills through a delegated commission in the Ministry of Health attached to the portfolio of services or that is linked to the Interterritorial Council”. Regarding who she teaches, Llerena considers that there is room for scientific societies, universities and research centers.
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