The Science
Advances in medical science create opportunities to improve the lives of many millions of people. Let’s take a look at how we’re doing exactly that.
Pharmacogenomics is the study of how a person’s genes affect their response to drugs, foods, alcohol, and other substances. This exciting field of science combines pharmacology (the science of drugs) and genomics (the study of genes and their functions) to determine safest and most effective medications, and the optimal doses allowing treatment regimens to be tailored to each person’s genetic makeup.
Pharmacogenomic tests identify which prescription medications are safest and most effective for you based on your genetic makeup. You and your physician will receive concise, actionable reports for personalizing your prescriptions.
Who should receive pharmacogenomic testing?
Pharmacogenetic testing should only be performed based upon medical necessity. The physician determines medical necessity and only a physician can write an order for testing (in the US). The following situations may qualify as medical necessity:
Patients taking a large number of medications with the potential for serious adverse effects.
Patients taking medications with a high risk of drug interactions.
When patients do not respond to drug treatment and options are limited.
Patients with an unexpected pattern of side effects to medications.
Why Precision Medicine?
Because One Size Does NOT Fit All.
Unfortunately, one size does not fit all when it comes to prescriptions. Each patient’s DNA is unique, and genetic factors can account for up to 95% of drug response in an individual. In the example below, you can see how pharmacogenetic testing works within a grouping of people who would all generally be prescribed the same drug:
Good Responders to Drug A
Slightly more in-depth explanation.
Good Responders to Drug B
Slightly more in-depth explanation.
Good Responders to Drug C
Slightly more in-depth explanation.
Treatment Resistant or Refractory Patients
Slightly more in-depth explanation.
PGx Supporters:
The Research:
Adverse Drug Events are dramatically on the rise.
Preventable adverse events are a leading cause of death in the United States. When extrapolated to the over 33.6 million admi ssions to U.S. hospitals in 1997, the results of these two studies imply that at least 44,000 and perhaps as many as 98,000 Americans die in hospitals each year as a result of medical errors. Even when using the lower estimate, deaths in hospitals due to preventable adverse events exceed the number attributable to the 8th-leading cause of death. Deaths due to preventable adverse events exceed the deaths attributable to motor vehicle accidents (43,458), breast cancer (42,297) or AIDS (16,516).
Total national costs (lost income, lost household production, disability, health care costs) are estimated to be between $37.6 billion and $50 billion for adverse events and between $17 billion and $29 billion for preventable adverse events. Health care costs account for over one-half of the total costs. Even when using the lower estimates, the total national costs associated with adverse events and preventable adverse events represent approximately 4 percent and 2 percent, respectively, of national health expenditures in 1996. In 1992, the direct and indirect costs of adverse events were slightly higher than the direct and indirect costs of caring for people with HIV and AIDS.
Elderly patients taking multiple medications are at a greater risk of suffering an ADE.
International research shows that polypharmacy is common in older adults with the highest number of drugs taken by those residing in nursing homes. Nearly 50% of older adults take one or more medications that are not medically necessary. Research has clearly established a strong relationship between polypharmacy and negative clinical consequences. Moreover, well designed inter-professional (often incuding clinical pharmacist) intervention studies that focus on enrolling high risk older patients with polypharmacy have shown that they can be effective in improving the overall quality of prescribing with mixed results on distal health outcomes.
Older adults with polypharmacy are predisposed to drug- interactions. In a prospective cohort study of older hospitalized adults taking 5 or more medications, the prevalence of a potential hepatic cytochrome enzyme-mediated, drug-drug interaction was 80%. The probability of a drug-drug interaction increased with the number of medications. Specifically, a patient taking 5-9 medications had a 50% probability whereas the risk increased to 100% when a patient was found to be taking 20 or more medications. In a study of community-dwelling elderly adults, almost 50% of patients had a potential drug-drug interaction. Drug-drug interactions are a frequent cause of preventable ADEs and medication-related hospitalizations, thus practitioners should keep the possibility of a drug-drug interaction in mind when prescribing any new medications.
The opoid epidemic is doomed without precision medicine.
Drug, alcohol and other addiction rehabilitation in the United States was a $35 billion business in 2015. There are over 14,500 treatment facilities and growing. A total of 2.5 million patients received treatment, but much more need it and many facilities are at capacity. Additionally, insurance coverage for rehabilitation is limited. As a result, most of the bill is paid by government/state agencies or out of pocket by the patients. High-end establishments have emerged for the higher income population, and new nooks are developing in areas such as: problem gamblers, sex addiction, nicotine addiction and Internet addiction. Facilities are also diversifying into treating people with anxiety disorders, eating disorders, and posttraumatic stress.
Similar to illicit substance abuse, the patterns observed in the market for prescription painkillers like oxycodone addiction have skyrocketed in recent years. In the 1990s, there was an increase in the accessibility of prescription painkillers. This culminated in a crest of addiction, which surpassed the combined use of illicit substances (i.e., LSD, methamphetamines, ecstasy, and cocaine). In 2012, the mortality was 16 thousand deaths due to painkillers and thus, clinicians, regulatory agencies, government and other professionals have been working to counter the excessive use of prescription painkillers. For example, oxycodone is now being produced so that it cannot be easily crushed to allow for dissolving for injection or even snorting.