Earlier in summer 2024, this year’s ‘OPERA 24’ nomination and judging process concluded, resulting in the announcement of a shortlist and an overall winner. The second annual ‘Outstanding Pharmacy Early-career Researcher Award’, granted by the Royal Pharmaceutical Society (RPS) and The Pharmaceutical Journal, attracted an impressive list of nominations and a competitive shortlist, showcasing the breadth of pharmacy topics being investigated right now by future research leaders within our profession. Zoe Edwards applies her research skills across a range of practice-relevant questions including how to engage other primary care staff to take part in research; Anneka Mitchell researches patient safety in older people; Anna Robinson-Barella examines solutions to health inequalities in vulnerable and marginalised communities; Ryan McNally focuses his research on personalised medicine approaches for treating hypertension, with a specific eye on reducing health inequalities; and Sion Scott — the overall winner — applies behavioural science to medication optimisation.
As well as their own successes, what these candidates show is that no research area is out of bounds for those working in pharmacy, and that anyone can get started in research, regardless of their background. Lived experience has been a clear motivation for several of the candidates and gives impetus to their work, illustrating that those who start out on a practice-based path can change it to focus their careers on research at any time during their career. After all, aren’t all pharmacists familiar with and doing something akin to research in their roles, and thus ‘researchers’ at heart?
I am not alone in asking such a question. Recently, there has been much debate about what distinguishes research from other pharmacy activities of a similar vein. To answer this, I propose the following: all pharmacists undoubtedly engage in what we might call ‘processes of inquiry’ in their day-to-day roles; activities that collect and create information against a specific question. They might then ‘evaluate’ such information to determine its merit, worth or value, allowing them to make a work-based decision, for example about a service. Such activities might include surveying patients to receive feedback on care provided to them; completing service audits against official standards; or engaging in quality improvement projects.
However, while such activities will overlap with activities of ‘research’, it must be remembered that the latter is more formally thought of as activity that generates new knowledge and answers specific research questions or hypotheses for wider application and ultimate publication. But perhaps dichotomising in this way is not helpful to our professional development. After all, quality improvement projects, audits and surveys are the very processes that help improve the delivery of pharmaceutical care and arguably provide the foundation of skills needed to then undertake and generate new, publishable research.
To my delight, one of the papers I reviewed focuses entirely on pharmacists and research. ‘Predictors of confidence in research: a cross-sectional survey of pharmacists in the north of England’, published on 23 July 2024 in the International Journal of Pharmacy Practice. The researchers, a collaboration of academics and clinical practitioners, use a survey to establish if participants’ self-reported confidence in their ability to meet the research learning outcomes in the RPS ‘Post-registration foundation’ and ‘Core advanced pharmacy’ curricula can be anticipated. In terms of the findings, as might be expected, recent experience of research or related activities, a postgraduate qualification in research, and other research training were all associated with self-confidence, as it was measured. Interestingly, another factor associated with self-confidence (in being able to meet the research learning outcomes) was a discussion about research in work appraisals, but protected time for research was not. Perhaps, as the authors explain, the latter finding can be explained by the idea that pharmacists might be undertaking research outside of working hours. The paper provides more nuance and is worth a detailed read.
On the topic of pharmacists conducting research, the second paper that caught my attention is a systematic review led by a pharmacist working within the field of genomics. ‘A systematic review of aspects of NUDT15 pharmacogenomic variants and thiopurine-induced myelosuppression’, the paper is published on 6 July 2024 in the newest of the RPS journals, RPS Pharmacy and Pharmacology Reports. The introduction of the paper explains that variability in how individuals respond to medicines can be attributed to their genomic make up, altering the pharmacokinetic profile of a medicine or its pharmacodynamics, resulting in risk of drug ineffectiveness or toxicity. Pharmacogenomic testing of an individual then could guide what is prescribed to them to minimise these risks. The particular focus of this study was thiopurine drugs used, for example, in the treatment of inflammatory bowel disease, which are associated with thiopurine-induced myelosuppression (TIM), a serious side effect where the amount of blood cells the body produces is significantly reduced.
As explained by the authors, the relevance of pharmacogenomics here is that variants within specific genes of two enzymes responsible for the metabolism of 6-thioguanine nucleotide (6TGN) can result in accumulation of this active metabolite and toxicity, including TIM. The two enzymes are thiopurine-S-methyltransferase (TPMT) and nudix hydrolase 15 (NUDT15), with variants in the former described as being more common in those with European ancestries and the latter, being predominantly present in those of Asian ancestry.
The paper itself is a pragmatic one, seeking to understand the clinical utility of NUDT15 genotype-guided treatment within practice, with four distinct objectives, one of which (review of association data for NUDT15 variants with TIM in all indications) focused specifically on those with European ancestry, addressing current knowledge gaps. Ultimately, the authors state that while studies were generally small, heterogenous, and of variable quality, their analysis shows an association with TIM in NUDT15 variant heterozygotes and Europeans, thus illustrating potential for genotype-guided dosing to reduce TIM. However, the health economic analyses found TPMT/NUDT15 genotyping cost-effective in Asian populations, but this was not the case when a European population was considered. As ever, much remains unexplored and left to others to take on.
So, as I mentioned in the PJ Pod episode ‘Getting into research’, published in June 2024, we need to decide — as a profession and as individuals — who is going to do the research that is fundamental to pharmacy? Is it going to be others or is it going to be pharmacists? You choose.
