The previous two chapters have shown how the current consensus view of clinical APOE4 testing for both differential diagnosis of Alzheimer's and the prescription of Tacrine and other acetyl cholinesterase inhibitors has come about. In general, there is significant reluctance to introduce APOE testing into the clinic, a reluctance based on a complex mesh of technical, social and ethical factors. At the same time, there is widespread APOE genotyping in the research setting, both academic and commercial, and increasing interest in bringing APOE into the clinic. This final chapter on Alzheimer's disease explores the role of APOE genotyping in current pharmacogenetic research and how this relates to industry concerns. It also uses theoretical ideas from the sociology of science to explain the differences between expectations and the coalface in Alzheimer's pharmacogenetics, and to get to grips with the source and solutions to clinical resistance.

APOE testing in research and the clinic

Although resistance to clinical APOE4 testing is strong, there is a great deal of genotyping going on in specialist Alzheimer and memory clinics throughout the US and the UK. While the location for such testing may be the same as for clinical treatment, the motivation of this work is ostensibly quite different.