Lynn Dressler, DrPH

Assistant Professor

Division of Pharmaceutical Outcomes and Policy

 

Associate Director for Policy and Ethics
Institute for Pharmacogenomics and Individualized Therapy

 

Research Interests

Lynn Dressler’s background spans translational research in breast cancer, health policy and bioethics. Her training and experience in the policy arena, coupled with the ethical issues associated with human genetic and genomic research, serve as a bridge between scientific discovery and practical implementation. Overall, her interests are to address the policy and ethical issues faced in integrating pharmacogenomics into clinical practice and integrating research ethics into the scientific process. 

During a genetic research study evaluating response to cardiovascular drug therapy, a researcher discovers that a patient has a DNA sequence variation associated with a severe form of mental illness. The finding has nothing to do with the original study, but what is the researcher supposed to do with this finding? What responsibility, if any, does the researcher have to communicate this information to the physician or the individual? What criteria can guide this decision-making process?

These are the types of questions that Lynn Dressler, DrPH, addresses in her work.

As an assistant professor in the Division of Pharmaceutical Outcomes and Policy and associate director of policy and ethics for the Institute for Pharmacogenomics and Individualized Therapy, Dressler’s research addresses the many ethical, social, and policy issues that arise when integrating pharmacogenomics into clinical practice.

A relatively new field, pharmacogenomics uses the information in our genome to understand how we respond to drugs so we can get the right dose and the right drug the first time. Applying this genomics-focused branch of science to medical practice raises a number of issues, including the protection of an individual’s privacy, maintaining the confidentiality of information, and the potential for stigmatization and discrimination on the part of health insurers and drug developers toward individuals and their families as well as those of a common ancestral or cultural origin. Dressler tries to identify and address issues before they materialize, using social science and policy methods.

“A lot of times people think of ethics as a problem-identifying field,” Dressler says.

“I’m not interested in just identifying problems. I look at how we can resolve the issues—why the issues are barriers to begin with, what are the perspectives of the stakeholders who have an interest in the issues, and what is really at the heart of the issue. I want to figure out how we can overcome the challenges and which challenges require different strategies to address.”

Although there is a wide spectrum of ethical and policy issues associated with integrating pharmacogenomics into clinical practice, Dressler’s current research focuses on three main areas: when and if research results should be disclosed to individual research subjects, how stakeholders (FDA, Pharma, clinicians, consumers) decide when a pharmacogenomic test is ready for clinical use; and how the potential for stigmatization and discrimination influences uptake of pharmacogenomics by consumers.

Dressler says she is ultimately interested in how pharmacogenomics will improve patient outcomes and change the standard of care in medicine. She also wants to look at how it will affect reimbursement issues and liability for health care providers.

As pharmacogenomics becomes more widely used, Dressler is confident that it will help improve patient care and lower healthcare costs, but she is also sensitive to the issues that may arise and the ways in which they should be addressed. And she recognizes that genetics plays an important role in medicine, but that it isn’t the only consideration.

“I do think there’s information in your DNA that could be useful to your doctors and pharmacists and to you as an individual, but it’s not the only piece of information that is helpful,” Dressler says. “Our lifestyle and environmental exposures are also contributing factors.”

A Researcher’s Perspective

Trained in pathology and cell biology, Dressler spent more than twenty-five years as a laboratory researcher before changing her career focus to the ethical and policy issues of pharmacogenomics.

After earning a bachelor’s degree in biology from William Paterson University in New Jersey and a master’s degree in experimental pathology from the State University of New York at Buffalo, Dressler worked in experimental therapeutics with Margot Ip at the Roswell Park Cancer Institute. She then moved to San Antonio to train and work in the laboratory of the late William L. McGuire, an internationally known breast cancer researcher. It was under McGuire’s tutelage that she began her career in translational research, working at the interface between the laboratory and the clinic, and being involved in breast cancer clinical trial research. In 1993, Dressler came to UNC to conduct research in the Lineberger Comprehensive Cancer Center.

Working with one of the national cooperative oncology groups, the Cancer and Leukemia Group B (CALGB), Dressler and her laboratory at Lineberger performed the clinical research study demonstrating the clinical validity of the HER2 FISH assay (Abbott Pathvysion kit™), which led to the FDA approval of the test. The HER2 test, now used in the United States and Europe to predict response to immunotherapy and chemotherapy in breast cancer, is one of the leading examples of how the pharmacogenetics of somatic tissue can contribute to individualized therapy.

In 1996, Dressler served on the Ad-Hoc Committee for Genetic Discrimination Legislation, a part of the state-commissioned North Carolina Advisory Committee for Cancer Control and Coordination. In this role, she helped develop and advocate for North Carolina’s legislation to prohibit employer and health insurance discrimination on the basis of genetic information. The law was passed in 1998.

Dressler says that being involved in the legislative process was a turning point in her career that drove her to take a more policy-oriented approach to research.

“The passing of the legislation was a bittersweet victory,” she says. “Although we had some protections in place, it was only a beginning. Information related to family history could still be used to underwrite policies, but it was an incredible learning experience.

“I had recognized at that time there were so few scientists involved in the legislative and policy process. I really felt a responsibility as a scientist to be more involved in public and science policy and felt an obligation to ensure that we were not hurting the patients we were trying to help in our research. When we started evaluating genes like BRCA1, which are associated with inherited forms of breast cancer, we just couldn’t ignore the impact our research could have on people’s everyday lives.”

Dressler decided to pursue her doctorate in health policy, and she graduated from the Public Health Leadership Program at the UNC School of Public Health with her DrPH in 2003. She continued in the laboratory during this time, having been awarded a U10 from the National Cancer Institute and National Institute on Aging to study breast cancer in older women. However, she was ready for a transition. After completing a postdoctoral fellowship at the Center for Genetic Research Ethics and Law at Case

Western Reserve University, she returned to UNC in October of 2007 and became a faculty member in the School of Pharmacy.

Dressler has mixed feelings about leaving the laboratory setting behind, but she looks forward to her new career challenges.

“I’m sure I’ll miss it,” she says. “I’ve been trained as a pathologist, so I love looking through a microscope—it’s something that’s a part of who I am. But I really think I can contribute in a different way in a policy and ethics setting.”