Prescribe one pain medicine to a patient with a broken leg and it will work fine. Try that medicine at the same dose on another patient and it’s not enough, while a third person complains of nausea and vomiting. Pharmacogenomics seeks to predict the impact of genetic variation on a person’s response to medication in an effort to find the right fit for each individual. Could it save money? Perhaps.
The field is still in its early stages. Millennium Laboratories began offering pharmacogenomics testing in Hawaii last year.
Using saliva samples, Millennium tests patients for six different genes. The results of these tests are used in an attempt to predict how well each person is able to break down certain types of medications, including those to treat depression, anxiety and pain.
Patients who have a tendency to break down specific medication quickly may need higher doses, while those who do so more slowly might benefit from lower and possibly less frequent dosing.
Certain drugs, however, are broken down by the body in several steps. The first two steps, for example, may occur quickly while the last step occurs slowly. In this case, blood levels of a partially broken-down medicine could become dangerously elevated. This situation might result in a greater chance of side effects or more worrisome drug-drug interactions.
Should everyone be tested before trying an initial medication? Probably not. For now, pharmacogenetic testing is typically considered when a patient has tried several medications but has not been able to tolerate any of them. Using saliva to test one’s genetic makeup might help solve the problem by assisting the provider in finding the right treatment at the right dose.
As is typically the case, when a new product or service is approved by the FDA, the next challenge is to obtain insurance coverage. Pharmacogenomic testing is currently approved by some carriers, while others are still in the decision-making process.
Pharmacogenomics is a compelling new tool that has the potential to personalize medication choices. As this emerging field continues to evolve, it will deepen our understanding of the relationship between a person’s genetic makeup and the response to pharmaceutical treatment. As the process becomes more efficient and more reasonably priced, insurance coverage will improve.
Eventually, pharmacogenomics could minimize the need for trial and error to find the right medicines and result in not only fewer adverse effects, but also more efficient management of disease. Ideally, this may translate into better-quality care at a more reasonable cost.
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Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
