House of Lords evidence session highlights the role of clinical pharmacology in healthy ageing

The UK Government has adopted increasing health span as a policy objective in its Industrial Strategy “Ageing Society” Grand Challenge, which aims to ensure that people can enjoy at least 5 extra healthy, independent years of life by 2035. In July 2019, The House of Lords Science and Technology Committee launched an inquiry into Ageing to determine whether this ambition to increase health span is achievable in principle, and which approaches may be most successful in practice. The Society’s President Professor Sir Munir Pirmohamed gave evidence to the Committee in October 2019. He highlighted the important role that clinical pharmacologists could have in helping to achieve the Government’s 5-extra-healthy-years-by-2035 target, focussing on three main areas.

Supporting multidisciplinary teams of medicines experts

As the population ages, people increasingly have multiple co-existing chronic diseases (multimorbidity), necessitating the use of multiple medicines (polypharmacy). To deal with this growing clinical issue, Professor Pirmohamed noted the need for a multidisciplinary team skilled in medicines management, including care of the elderly specialists, clinical pharmacologists, pharmacists and general practitioners. As experts in prescribing medicines, clinical pharmacologists, in partnership with pharmacy, are well-placed to support training of these multidisciplinary teams to improve prescribing and make them more aware of drug interactions, adverse reactions and individual care needs of the elderly. Professor Sir Pirmohamed said:
 

Because of the multispecialisms we have, doctors, nurses and pharmacists are reluctant to deprescribe a drug when another clinician has started it. We need to change the medical model of care, from the highly specialised medical care model we have at the moment to a much more generalist care model with a multidisciplinary team that includes care of the elderly, people who know about drugs and general practitioners working together to tackle the problems. We need to think about how we develop our model of service for future years.

Realising personalised medicine

Pharmacogenomics is the study of the role of the human genome in drug response. Applying pharmacogenomic techniques, it is possible to analyse how the genetic makeup of an individual patient affects their response to drugs, which can be used to identify correct doses and prevent serious side effects. This means that pharmacogenomics has the potential to be used to tackle some of the problems associated with polypharmacy in older people. Clinical pharmacologists have the expertise to interpret and provide guidance on genetic test results and are providing leadership nationally and internationally in all aspects of pharmacogenomics, from variant discovery to implementation in clinical practice. In Professor Sir Pirmohamed's words:
 

[The value of clinical pharmacology is in] working with the genomics laboratories and being able to provide that interpretation and guidance so that we can use genetic testing appropriately. There are genetic tests that are already implemented in this country for pharmacogenomics, preventing serious side effects and trying to identify the correct dose, but it is done in specialist centres at the moment. Genomics England, the genomics laboratory hubs and NHS England are thinking about widespread implementation throughout the NHS so that all patients benefit and have equity of access.

Leading on drug development in the elderly

Most of the patients Professor Pirmohamed sees are on more than 10, and sometimes more than 20, drugs. These drugs are used at conventional doses that have been tested in younger populations—i.e. they have not been tested in people with multimorbidity, on multiple medicines. As such, a drug may act differently, and often results in increased drug/metabolite concentrations in the circulation and at the site of action in the tissues in the elderly because of impaired liver and kidney function and drug-drug interactions. As skilled researchers, clinical pharmacologists can lead on research into the issues facing the increasing elderly population such as appropriate dosing. Professor Sir Pirmohamed said:
 

To treat the elderly for the future, we need to think about how to dose them better. Paracelsus, 500 years ago, said that the dose is either the remedy or a poison. That is still true; we need to think about how we dose our elderly. They may require multiple drugs, which is important for treating their diseases, but we need to treat them with appropriate doses as well, which we do not.

In summary, an ageing population is a key reason why challenges in the use of medicines are increasing. As such, to deal with the challenge of an ageing population, the NHS workforce must be skilled in the use of medicines. Clinical pharmacologists, in partnership with pharmacy, are well-placed to lead on prescribing and responsibilities of all the staff to use medicines to best effect and safely. Further, most clinical pharmacologists hold an academic post; they are an important group of academic clinicians who can help lead research in their own right and support the whole workforce to be ‘research ready’ and ‘research active’ for the benefit of patients.

The British Pharmacological Society supports the Government’s ambition to increase health-span and has been working with other organisations to make the case for embedding research in the NHS, addressing multi-morbidity and polypharmacy, and implementing pharmacogenomics, which together could help reach the 5-extra-healthy-years-by-2035 target. These are all areas in which clinical pharmacology can help make an impact on the health of an ageing population.

However, as outlined by Professor Pirmohamed, clinical pharmacology within the NHS is an area of critical skills shortages; there are about 72 Clinical Pharmacology and Therapeutics (CPT) consultants in the UK. This compares to a Royal Colleges of Physicians (London) recommendation of a workforce of 440. Addressing this skills shortage is at the heart of the Clinical Pharmacology Skills Alliance (CPSA), a partnership formed by the Association of the British Pharmaceutical Industry (ABPI), the British Pharmacological Society (BPS), the Faculty of Pharmaceutical Medicine (FPM) and Health Education England (HEE), and co-chaired by Professor Pirmohamed.


 

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Read the full transcript of the evidence session

Watch the evidence session

Read the Society’s evidence submitted to the Ageing inquiry

Read more about the work of the CPSA

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