This paper aims to explore the perception of precision medicine (PM) and pharmacogenomics (PGx) among undergraduate and graduate students in Bangladesh. A cross-sectional survey was conducted among students from different universities across the country. The results of the survey showed that the majority of students had a positive attitude towards precision medicine and pharmacogenomics, perceiving it as a means to improve diagnosis and treatment accuracy. Furthermore, the majority of students also expressed a willingness to learn more about precision medicine and pharmacogenomics, suggesting that there is potential for these practices to be utilized in Bangladesh. Particularly in this study, 337 students from life science and relevant programs participated. The results of our study showed that 84% of graduate students and 74% of undergraduate students thought PM was a promising healthcare model. In addition, 39% of students are highly encouraged to pursue their post-graduation in the subject areas of PGx and PM in order to support patients. The majority (62%) thought that patient privacy was the ethical concern most closely related to pharmacogenomic testing, while 19% of respondents thought that data confidentiality was the key issue. The findings of this study provide insight into the potential of precision medicine and pharmacogenomics in Bangladesh and suggest that further research into the attitudes of healthcare professionals should be conducted in order to take full advantage of the potential of these practices.
Precision medicine is a novel approach to medical care that considers a persons genetic background, lifestyle, and environmental circumstances. It has gained popu-larity in recent years (Prajapat et al., 2020; Cheung et al., 2021). It is a strategy that is made probable by molecular diagnostics and contradicts the conventional method of treating all patients with the same state with the same medication and dosage (Mahmutovic et al., 2018). However, personalized medicine uses data about a parson particular genes or proteins to repel, diagnose or treat disease (Saud & Syed, 2022). Noti-ceably, it has the ability to shape various aspects of clinical practice from preclusion and early diagnosis to treatment of disease (Moses III & Martin, 2001).
The study of numerous genes or gene patterns while simultaneously examining the structure and expression of large sets of genes is required by pharmacogeno-mics research, which calls for a greater use of techni-ques specialized for such studies (Dhawan & Padh, 2013). Pharmacogenomics (PGx) investigates how var-iations in the human genome affect how an individual reacts to drugs. In twenty centuries, the human genome project (HGP) reported that humans have approxim-ately 20,500 genes and that 99.5 percent of the genes are analogous, whereas 0.5 percent of the genes have differences that are accountable for the specific groups and cause specific disease (Abou Diwan et al., 2019; Relling & Evans, 2015). Now, the emphasis has shif-ted to using genetic techniques to identify markers of therapeutic response. The number of SNPs linked to medication reactions will increase at a never-before-seen rate during the coming years. The task is to sort through the pertinent SNPs and show the clinical validity and efficacy of these SNPs as Pharmacoge-nomics indicators (Norton, 2002). SNP is the most prevalent type of DNA sequence variation observed in the human genome (Robert & Pelletier, 2018). There are approximately 11 million SNPs in the human geno-me, with an average of one every 1,300 base pairs (Madsen et al., 2007). A genomic investigation found that more than 99% of those assessed had at least one genotype linked to an increased likelihood of drug sen-sitivity (Reisberg et al., 2019).
Adverse drug reactions (ADRs) are the fourth major cause of mortality in the United States, and it is thought that 2.74 million ADRs and 128,000 fatalities are caused each year by prescription medications (Shepherd et al., 2012). As a result, one out of every five wounds or deaths among hospitalized patients are caused by ADRs, which have an annual cost of $136 billion greater than the combined expenditures of treating diabetes and cardiovascular disease (Shepherd et al., 2012). The goal of PGx discoveries is to maxi-mize the advantages of drugs while minimizing any negative effects and healthcare expenses (Uddin et al., 2022; Reisberg et al., 2019).
According to the recent pharmacogenomics report, the Food and Drug Administrations (US-FDA) collection of medications that have been labeled before use currently includes more than 350 drugs (Koutsilieri et al., 2020). These drugs are often referring to multiple pharmacogene, resulting in ~15% of all approved drugs having pharmacogenomics information on their labels (Relling & Evans, 2015; Kinsella & Monk, 2012). In order that pharmacogenomics and personali-zed medicine approach played a crucial role in pre-venting genetic disorder. However, the concern arises with genetic testing that must satisfy specific require-ments with respect to their clinical utility, clinical vali-dity, and analytical validity before use in clinical con-text (Burke, 2009; Issa & Keyserlingk, 2000). In addi-tion, concerns about the security and privacy of a pati-ents pharmacogenomics data are also raised by per-sonalized medicine approaches (Robertson, 2001).
The publics awareness of the molecular uses and characterization of PGx and PM during the COVID-19 outbreak in Bangladesh has increased because to the advancement of genome sequencing research (Khan et al., 2021; Ahammad et al., 2021; Akter, n.d.; Rahman et al., 2021). Surprisingly, there are presently no local studies that address the publics knowledge of and per-ceptions of PM, PGx, and genetic testing, as well as the coverage of PGx and PM education at the under-graduate and graduate level. Information is scarce from other regions of the world such as Bangladesh, but few studies are available from Asia (Cheung et al., 2021; Saud & Syed, 2022). The majority of the reported initiatives are concentrated in the USA and Europe (Swen et al., 2018; Volpi et al., 2018).
On the other hand, knowledge and awareness of these are crucial since they could be used as a guide when developing national policy and curriculum. This research article explores the attitudes, beliefs, and perceptions of undergraduate and graduate students in Bangladesh towards precision medicine and pharmaco-genomics practice. A qualitative approach was emp-loyed in order to gain insight into the participants perspectives. The aim of the study was to gain insight into the views and opinions of students in Bangladesh towards precision medicine and pharmacogenomics practice, and to provide a foundation for future res-earch on the topic. This study is significant as it provides valuable insight on the views of the student population towards precision medicine and pharmaco-genomics practice, which in turn can be used to provide a better understanding of the general popu-lations perspective, can also be used to inform future research on the topic, as well as provide a platform for further discussion on the implications of precision medicine and pharmacogenomics practice (Bienfait et al., 2022; Cecchin et al., 2020).
Study Design
This Cross-sectional research was carried out over the course of four months, from July 1 to October 25, 2022. The purpose of this population-based cross-sec-tional study was to examine the understanding, atti-tudes, and application of pharmacogenomics and per-sonalized medicine. A combination of qualitative and quantitative data was used to conduct the study. Cur-rent students from a number of Bangladeshi univer-sities qualified as participants.
The total number of 337 graduate and undergraduate students contributing to the survey were from life science backgrounds, as well as those with back-grounds in various fields outside of molecular life science and health science. They could communicate in English, ranged in age from 18 to 60, and were citizens of Bangladesh with various socio-economic backgrounds and educational institutions. On the basis of a question from the Mahmutovic et al. study, an online questionnaire was made and updated and given to participants to answer in order to learn how under-grads studying molecular life sciences and health felt about PGx and PM (Mahmutovic et al., 2018). Each and every participant was fully informed of the studys purpose prior to the data collection.
Sampling and Data collection
The 39 questions in the survey were separated into three groups as follows: Part 1 consists of demographic information, including ages, gender, and educational attainment. Part-2 consisted of 15 to 20 questions ab-out pharmacogenomics and personalized medicine and was concerned with the knowledge and awareness related questionnaire. Part-3 of the survey included five to seven multiple-choice questions about respon-dents opinions about pharmacogenomics and the prac-tice of personalized medicine. Key definition of per-sonalized medicine and pharmacogenomics/ pharm-acogenetics tests were provided to the participants in the instructions section of the survey. There were yes/no/I dont know (not sure) questions in the survey. The survey also included multiple-choice questions and a Likert scale for rating of agreement with various statements (i.e., agree, disagree, no opinion, neutral). An introductory cover page was attached describing the purpose and objectives of the study and inviting the students to participate in it.
Statistical analysis
All categorical variables were presented as frequencies and percentages, including participant demographics, professional information, and responses to questions concerning participants opinions of PGx and PM. Data analysis was conducted using Microsoft excel and SP-SS software. In order to calculate proportions, descri-ptive statistics were utilized. The understanding, pe-rception, and practice of pharmacogenomics and pre-cision medicine were tested using the Chi-square test to determine the relationship between demographic factors and responses.
The p values were determined via chi-square analysis. All statistical tests were performed with a significance threshold of 5%, and the odd ratio (OR) and the correspondence 95% confidence intervals (CI) were computed.
Participants demographics
Table 1 summarizes the students demographic infor-mation as well as their employment history. The cur-rent study included 337 students who consented to fill out the questionnaire. Most of the students were aged between 19-26 years. Among the 337 participants, 257 were undergraduates and 80 were graduates. Among them, 180 (53%) were the female and 157 (47%) were male.
Table 1: Students demographic characteristics and professional information.
*MLS & HS= Molecular Life Science & Health Science, this area includes Biochemistry & Molecular Biology, Genetics and Biotechnology, Medicine, Health Studies, Microbiology, Pharmaceutical Sciences. **Non-MLS & HS= Non- Molecular Life Science & Health Science, it includes Computer Science, Electrical and Electronic Engineering, Journalism, Anthropology, BBA.
Students attitudes towards pharmacogenetics pra-ctice and personalized medicine
Table 2 shows the various questions and responses used to assess pharmacogenomics knowledge. Partici-pants replies to almost all survey questions regarding their awareness and attitudes towards genetic testing, pharmacogenomics, and personalized medicine. A par-ticular drug did not work for roughly 40% of parti-cipants from the fields of medicine, pharmacy, health studies, genetics, and bioengineering, while 31% of these students had an adverse drug reaction.
Table 2: Students attitudes towards pharmacogenomics practice and personalized medicine.
*MLS & HS= Molecular Life Science and Health Science.
Significance of pharmacogenomics education
The findings in Table 3 and Table 4 show that medi-cal, pharmacy and heath studies students have similar perspectives on their study curriculum and future plans for PGx. Overall, 84% of graduates and 76% of under-graduates believed that PM is promising healthcare model. The majority of undergraduates, 82% (212/257) agreed that PGx should be relevant to their curriculum, and 42% (108/257) thought their curriculum was well-designed for PGx.
The curriculum wasnt well-designed for PGx, accor-ding to 31% of respondents (81/-257) and 39% (100/ 257) want to continue their postgraduate education (masters, PhD, specializations) in the field of persona-lized medicine. According to our findings, students opinions toward their course of study and their desire to pursue postgraduate research in the field of persona-lized medicine are both highly influenced by the subject of study. When compare to other responders, it seems that more Biochemistry and Molecular biology students would like to pursue post-graduate study in this area.
Additionally, our findings imply that students are more likely to pursue postgraduate studies in the field of personalized medicine if they consider their degree program is well-designed to give them a sufficient understanding of PG. In their future practices, more than 70% of undergraduates and recent graduates feel that they should be able to recognize patients who might benefit from genetic testing, as well as be able to address patients inquiries about PG and PM and recognize medications that call for pharmacogenomics testing before being administered to the patient.
Table 3: Students opinion regarding the study curriculum and their future plans in pharmacogenomics.
Table 4: Students attitudes towards continued education in pharmacogenomics.
MLS & HS= Molecular Life Science & Health Science.
Students awareness about the ethical, legal and social implications
According to our findings, 54% of all the students who took part in the study are aware of the various ethical issues surrounding genetic testing. Most of the respon-ders (62%) believe that patient privacy was the ethical concern most closely associated to pharmacogenetic testing, whereas just 19% thought that data confide-ntiallity was the main problem. Other ethical issues, such as racial issues, non-incidental findings and stig-ma, were selected by 5%, 7% and 5% of students, res-pectively. Our findings indicate that 74% of students are concerned that PG test results might be disclosed to unauthorized parties. This concern was echoed by students in all faculties. Furthermore, 53% of students trust that revealing an unfavorable test result would be a disadvantage at work or in job-searching and they are also worried that they would feel “helpless” or “pessi-misti”.
Table 5: Students awareness and opinion regarding the ethical, legal and social implication.
MLS & HS= Molecular Life Science & Health Science.
Table 6: Students awareness toward diagnosis of diseases and treatment option.
*MLS & HS= Molecular Life Science & Health Science.
One of our studys unique features is that it is the first study to examine graduate and undergraduate students from multiple different universities in Bangladesh about their knowledge of and attitudes on the part of pharmacogenomics and precision medicine. Our find-ings indicated that molecular life science and health students are typically aware of pharmacogenomics and have a basic understanding of personal genome testing companies. Students in non-molecular life sciences, as opposed to, appear to be less aware of these companies and less interested in using PM as a novel healthcare model than students in molecular life science. Here, we also demonstrated that the majority of graduate and un-dergraduate students think that PGx should play a sign-ificant role in their academic program and that higher than 50% of these students would like to pursue post-graduate studies in the area of customized medicine (Guy et al., 2020; Nickola et al., 2012). Most of the faculties may not have PGx-related courses included in their curriculum, as just one-third of all students who took part in our survey believed that their study curri-culum is properly prepared to understand PGx. In a recent survey, it was discovered that the vast majority of the students in Californias eight pharmacy schools were knowledgeable about pharmacogenomics, con-curred that pharmacogenomics is significant for future pharmacists, and expressed interest in following a PGx residency, fellowship, or career. However, Latif (Latif & McKay, 2005) noted that only a basic understanding of PGx was being taught in the USA by 2005, empha-sizing the requirement to include PGx in the pharmacy curriculum. Direct-to-consumer genetic testing (DTC-GT) companies have risen in recent years, offering substitute information on genetic testing (GT) and per-sonalized medicine (PM), while highlighting the rema-rkable benefits of genomic medicine for particular healthcare management. Although students knowledge about genetic testing, precision medicine, and pharma-cogenomics may be largely based on information and advertisements from the direct-to-consumer genetic testing (DTCGT) industry, which may contain inaccur-acies and overstatements, rather than more accurate information acquired from their academic curriculum (Zayts & Luo, 2017; Rafiq et al., 2015). As seen by the low number of students expecting to continue their postgraduate studies in PM, undergraduates find it challenging to acquire a great interest in future exp-loration of such topics without a thorough knowledge of PM, PGx, and GT. So, by focusing more attentions and resources on academic study and profession deve-lopment in PM and PGx, there is a high chance that genomic medicine will be promoted thanks to a strong base of knowledge and widespread support. According to our finding, 76% of undergraduate students believed PM to be a promising healthcare model, and 54% said they would think about getting a genetic test. Initial instruction in genetics and genomics starts in high school in Bangladesh, but it does so in kindergarten through primary school in other western nations like the United States. Kindergarten students in the USA are exposed to the fundamental ideas of genetic inheri-tance through the application of relatable cases, such as cats giving birth to kittens with distinct markings, to show how features can vary. Due to this, the edu-cational system in the USA provided evidence that genomic education could be implemented and a solid foundation in genetics could be built at an early learn-ing stage (Campion et al., 2019; Learning & Curri-culum, 1964). The general issue of inadequate educa-tion and talent progress in PM and PGx may be exag-gerated due to the slow local progress of PM and PGx until recent years. Bangladeshs practice of PGX is still in its infancy compared to other countries.
Negative attitude toward genetic testing results due to ethical, legal and social implications
It has been established that students who took part in our survey are aware of the various ethical issues sur-rounding genetic testing. Interestingly, our findings showed that majority of the students seem to be con-cerned about the patients privacy and data confi-dentiality. More than 40% of Bangladeshi undergrad-duates demonstrated a negative outlook in the event of a poor GT result, including feelings of "helplessness or pessimism," "different or inadequate," and "disadv-antaged" job seeking, with students older than the age of 19 more inclined to agree with this statement (Hunt et al., 2003). The propensity of pessimism among local undergraduates may be explained by the fact that Asians are typically more pessimistic than other ethnic groups. According to a research by Chang et al. Asians Americans are generally more pessimistic than cauca-sian Americans (Chang, 1996). Similarly, results were found in another study by Lee et al. which showed that Caucasia American students and Chinese American students both had higher levels of pessimism than mainland Chinese students and Chinese American stu-dents, respectively (Brookfield, 1984). Although the tendency of pessimism about poor GT results id parti-cularly pronounced and widespread among Bangla-deshi undergraduates, the highlighting causes of pessi-mism as well as potential solutions to reverse the trend should be thought about and carefully addressed. Sur-prisingly, our study showed that nearly half of all res-pondents were concerned that PGx test results would be disclosed to unauthorized parties. Students who are concerned that PGx testing would show they have extra risk factors for other disease would similarly feel "different" and "inadequate" in the event of negative test findings. Otherwise, numerous participants clai-med that they wouldnt feel “helpless,” “pessimistic,” “different,” or “inadequate.” This meant that every person would respond to the genetic test results diffe-rently. Patients are thought to need sufficient counse-ling in order to understand the significance of the test results in relation to their particular health (Winkler & Wiemann, 2016; Howard & Borry, 2013).
One of the most significant strengths of our study was the recruitment of a diverse group of health science students from across the nation in three different set-tings (medicine, pharmacy, and health studies), as well as genetic students and students from other non-mole-cular life science and non-health science departments. Our findings were further strengthened by the com-parison of the thoughts and attitudes of students who had taken the PGx course and those who had not. Our survey explored students interest in the learning more about PGx.
This study provides evidence of how undergraduate and graduate students in Bangladesh perceive PM and PGx. Our findings show that, with the exception of graduate students from Bangladesh, the majority of undergraduate students who participated in our survey are enrolled in life science programs. However, they believe that PM is a promising new healthcare model but their knowledge, understanding regarding the tech-nologies, applications and implications of the field are very poor. The vast majority of students studying molecular life and health science made it apparent that they wanted to learn more about this area of study. This suggests that study programs in the field of PG should be developed in order to offer future healthcare professionals with the knowledge, abilities, and atti-tude necessary to conduct personalized medicine. Thus, it would be vital to improve coordination bet-ween universities, healthcare organizations, and gov-erning bodies in order to include more training and continuing education themes about pharmacogenomics and personalized medicine. In order to ensure the widespread clinical adoption of personalized medicine, it is crucial to expand the pharmacogenomic path of biological education.
The authors are thankful to the study participants. Also, the authors are grateful to the faculty members of different Universities to encourage their students to participate this research in Bangladesh.
There is no conflict of interest in the publication of this work.
Academic Editor
Md. Ekhlas Uddin Dipu, Department of Biochemistry and Molecular Biology Gono Bishwabidalay, Dhaka, Bangladesh.
Chief Mentor, Research Internship Program, BioIcon Academy, 64/1 (B1), Dolphin Goli, Kalabagan, Dhaka-1205, Bangladesh.
Khanom NI, Nur S, Mustari SS, Jamila O, Dat ASA, Hasan MM, Mahim M, Bristy FF, Tamanna N, Hossen MM, Das SK, Ahmed T, Sapon MA, Islam MS, Islam MM. (2023). Exploring the attitudes, beliefs and perceptions of undergraduate and graduate students in Bangladesh towards precision medicine and pharmacogenomics Practice: a qualitative study, Eur. J. Med. Health Sci., 5(2), 26-38. https://doi.org/10.34104/ejmhs.023.026038