Is there a need for PGxceptionalism

In a recent commentary in Clinical Pharmacology and Therapeutics, Altman1 declares that the implementation of pharmacogenomics (PGx) “requires that we separate it from other elements of genomic medicine.” He argues that PGx tests “need only reach reasonable expectations of noninferiority (compared with current prescribing practices) to merit use.” In his view, the implementation of PGx is less challenging than the use of genomics for estimating disease risk and prognosis, because genetic tests for drug response phenotypes offer better explanatory power and less risk for discrimination or misinterpretation. He also believes that cost-benefit analyses for PGx are not necessary because “genotyping is asymptotically approaching no cost” and positive test results are unlikely to lead to “spiraling follow-up test costs.”