Clinical and Ethical Considerations in Pharmacogenetic Testing: Views of Physicians in 3 "Early Adopting" Departments of Psychiatry

Objective: Pharmacogenetic testing for polymorphisms affecting drug response and metabolism is now clinically available, and its use in psychiatry is expected to become more widespread. Currently, few clinical and ethical standards exist for the use of these new tests. As a step toward building consensus about testing, we assessed the attitudes and practices of psychiatrists at 3 academic departments of psychiatry where pharmacogenetic testing is clinically available. We hypothesized that testing would be used primarily in treatment-resistant illness and that clinicians would believe such tests carried little risk.

Method: Residents and faculty at 3 departments of psychiatry considered to be "early adopters" of pharmacogenetic testing were invited during the academic year 2006-2007 to complete an Internet-based survey, including questions regarding clinical practices and opinions about testing utility, risks, and necessary safeguards.

Results: The 75 respondents had ordered pharmacogenetic testing a mean of 20.86 times in the previous 12 months. Testing was judged most useful in cases of treatment-resistant depression and medication intolerance. There was a lack of consensus about the risks of testing, particularly the risk of secondary information about disease susceptibility. Respondents endorsed the use
of several safeguards, including confidentiality,
pretest and posttest counseling, and informed
consent, but consensus about other safeguards
was lacking. Women and those who had not
ordered testing in the prior year were more
concerned about risks and need for safeguards
than were men and those who had recently
ordered testing.

Conclusions: Physicians at early adopting departments of psychiatry endorsed the clinical utility of pharmacogenetic testing and the use
of some patient safeguards, but showed a lack
of consensus about other safeguards and risks.

J Clin Psychiatry 2010;71(6):745-753

Submitted: September 4, 2008; accepted January 30, 2009.

Online ahead of print: March 9, 2010 (doi:10.4088/JCP.08m04695whi).

Corresponding author: Jinger G. Hoop, MD, MFA, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 (jhoop@mcw.edu).