The Best Medications For Your Genes 75
blackbearnh writes "Until recently, physicians prescribed drugs to patients with dosages based only on weight, and with no idea if the drug would be effective for that particular person. But as this article on Forbes.com highlights, the same advances in genomics that are letting people know about their likelihood of getting certain diseases can also let doctors know what drugs, and what dosages, will be likely to do the most good. 'Tamoxifen, the much-heralded cancer-fighting drug, has been shown to have little benefit for 7% to 10% of patients taking it. In the past, we would have just said that it works 90% of the time. But now, with our new genomic knowledge under our belt, we can say that it works nearly 100% of the time for people with the 'right' version of the CYP2D6 gene, and 0% of the time for people with the 'wrong' version, who make up roughly 7% to 10% of the population.'"
next up.. (Score:5, Insightful)
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It's not hard to imagine a future in which patients entering an emergency room will have a CD disc with their entire genome tucked in their wallets or on file with a national database. Before any drugs are administered, dosages will be adjusted based on the patient's genomic profile.
And that same genomic profile will determine if they can get coverage in the first place. Think of the cost reductions this new streamlined process will bring!
I mean, we just need this national database to better serve you.
Re:next up.. (Score:4, Informative)
Re:next up.. (Score:5, Insightful)
And are you confident, given the current level of lobbying, that the U.S. government won't pass the "Comprehensive, Affordable, Reliable, Effective Health Act"? I mean who would vote against the C.A.R.E health act that's "designed to lower health premiums for hard working American families"?
You might be surprised how much more power the industry will gain if public options fail.
Re:next up.. (Score:4, Insightful)
No, I'm not that confident, but I'm taking a chance on the 23andme.com database security anyway. Just signed up and the contract does give one pause. They point out that loose talk with your doctor can be dangerous. I don't know how far law will protect a person against medical and employment discrimination in practice but they mention that the law does not protect your ability to get _life_ insurance.
On topic, they routinely test for warfarin sensitivity and Plavix efficacy.
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Thank FSM! I was wondering if susceptibility to heart disease, cancer, etc, could render those diseases to be pre-existing conditions.
Public healthcare (Score:2, Insightful)
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Hey man, there needs to be competition to foster new innovations in a...fairly static and sedentary industry.
I mean come on, competition exists in health care since one provides service A and the other provides...the exact same service.
Alright, someone tell me exactly how insurance companies compete with each other to foster new innovations. Hell, internet providers have at least newly developing tech for new, faster internets (although not so much in the US of A) but what can insurance companies do? Patent
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Re:Public healthcare (Score:4, Insightful)
Hey man, there needs to be competition to foster new innovations in a...fairly static and sedentary industry.
I mean come on, competition exists in health care since one provides service A and the other provides...the exact same service.
Alright, someone tell me exactly how insurance companies compete with each other to foster new innovations. Hell, internet providers have at least newly developing tech for new, faster internets (although not so much in the US of A) but what can insurance companies do? Patent drugs or new procedures so only insurance provider A can provide it?
Are you joking or just really fucking dumb? The comptetition does exist -- but in medicine -- where there are innovations. In hospitals however there are protocols and rules. Doctors don't "invent" anything. Denying people healthcare because they cannot afford it does not foster new innovations -- it fosters death and diseases. Diseases which later on are mutated and spread on to you, simply because the people around you couldn't afford the bill. You have to be one dumb motherfucker to not get this -- really.
In other news, say what you want about republicans or democrats, but to fight against a public healthcare system without realising how self destructive that is takes one ignorant fucker. Unfortunately in a democratic system that ignorant fucker could eventually be responsible for the state of my health -- no matter how rich or poor I am.
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Umm, did you read the post you were replying to? He's on your (and incidentally, my) side.
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Umm, did you read the post you were replying to? He's on your (and incidentally, my) side.
In all fairness I did ask if he was joking. I'm a bit feisty today, I admit. But since we all agree let's gather and sing kumbaya. ;-)
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You have to be one dumb motherfucker to not get this -- really.
Well, he has to be dumb not to get it, but he doesn't have to fuck anybody's mother. Hell, he's probably a twelve year old virgin.
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Somebody please mod the parent up! Except that it's not "many" countries that have public health care, it's MOST countries. We're the only industrialized nation in the world without it, which is why our health care costs way more per capita than any other country's, and we don't have the best care by any metric at all.
So the only place this will be a problem is in the US.
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Just some examples. I'm not an expert so I can't think of any more.
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What is this insurance you speak of? In my socialist hell hole we cannot be denied coverage, meaning things like this makes healthcare better, more effective, potentially cheaper (rarely do things get cheaper in this socialist paradise though..) and probably saves lives..
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Actually, its already here.
The "The Newborn Screening Saves Lives Act of 2007" signed by Bush allows the government to collect, store, test and experiment on the genetic material of every newborn in America without the knowledge or consent of the parents.
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getting denied health insurance for having bad genes
The federal Genetic Information Nondiscrimination Act [wikipedia.org] is designed to prevent this. There are also supplementary state laws in, for example, Oregon and New Jersey.
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The federal Genetic Information Nondiscrimination Act is designed to prevent this. There are also supplementary state laws in, for example, Oregon and New Jersey.
I'm quite sure that if the insurers find something wrong with your genes, they can come up with a creative non-gene-related reason for not offering you insurance. Have fun proving that you were discriminated against because of your genes.
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So I should be denied the medicine that cures me because you're worried about your health insurance?
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How did I know, as soon as I read TFS, that this sentiment would lead the discussion? For a community that claims to be "nerd"-centric, we have the highest concentration of luddites I've ever seen.
Yes, the nature of risk-pooling groups is that those who are positioned to skim from the pool have an incentive to keep 'high cost' or 'high risk' members out. They always have. They always will. And contrary to a few other posters' responses, public healthcare doesn't fix it - it merely ensures that the entit
indications (Score:2, Insightful)
Bidil prescriptions should have been based on genetic markers. On the other hand, it's hard to do a credible whole-genome analysis for this sort of thing without a good theory in the first place.
placebo (Score:3, Interesting)
Re:placebo (Score:5, Funny)
How about placebos? I suspect they might work much better on some people than others.
Very true. I have friends that think they're worthless. But I only have to take 4 of them (1 in each corner of the room, at 9:04am, without exhaling) and my OCD stays completely under control. They make a world of difference.
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Do you drop a cockroach down your underwear before taking the pills?
I hear they stop working if you don't drop a cockroach down your underwear first.
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There's some weird evidence that placebos don't do what 'everyone' thinks they do.* It's not conclusive, but maybe we literally don't have a method to test your suspicion.
* Short form, opiate blocking drugs also block placebos if these are given as pain relievers, and maybe don't block them if they are given for other reasons.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T0K-3W0NBP2-1C&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrI [sciencedirect.com]
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Unless I misunderstand the link, for the people who experience the placebo effect for pain relief, naloxone blocks the effect, and proglumide increases the effectiveness. But for the people who don't experience the placebo effect neither of them do anything.
If that's the case I don't see how that prevents anyone from testing my suspicion.
But it may well that a person that's susceptible to placebo pain relief might not be susceptible to placebo treatment for something else. However that would also be worth i
version controll (Score:3, Funny)
They should have used git for version control.
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Actually, they store 'em in databases. A fixed summary would read:
... "right" allele of the CYP2D6 gene
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That may be the most inexplicable use of mod points I have ever seen.
(The parent is currently modded -1, redundant.)
Tailoring Medicine to Genes: What took so long? (Score:1, Insightful)
Religion is any collection of assertions that are prohibited from being questioned or verified. We simply assume them to be true.
In the case of medicine, one type of religion is the assertion that both men and women exhibit no differences in responding to treatment by the same drugs. About 15 years ago, the medical community admitted that this assertion is false [womenshealthresearch.org]. Congress be
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Despite more than 1 billion Chinese people out there, so far none have done very well in the 100m sprinting event. Don't see any Usain Bolts coming from those lines any time soon... There are just a few million Jews, but they have contributed disproportionately in so many fields - science and arts. And great influence in other fields such as finance.
I believe there are
Re:Tailoring Medicine to Genes: What took so long? (Score:5, Insightful)
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There may indeed be karate genes, after all I doubt a hamster is going to win any world karate championships. But the karate related genes are many and have multiple purposes.
Seriously though, winning a 100m race just involves you running faster than the rest - far simpler process (not sa
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> And great influence in other fields such as finance.
Er, you should have stopped while you were ahead?
> I believe there are breeds of humans just like there are breeds of dogs.
You really should have stopped while you were ahead!
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> You really should have stopped while you were ahead!
Sorry, I'm still ahead and not stopping for you. Try harder to keep up next time. I hope that's not the best you can do.
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When will we admit that there are genetic differences? For example, most East Asians suffer from lactose intolerance. Europeans do not.
You got that the wrong way . It should be: Most Europeans are mutant freaks that tolerate lactose as adults, while most East Asians still have the normal version of the genes that prevent the consumption of milk by adults (like most other mammals do).
That adult mammals do not tolerate lactose is the norm. Hence the lactose tolerance of Europeans is the exception.
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If evolution produces "mutant freaks" than every member of every species is a mutant freak. Lactose tolerance evolved because of a lack of food. Those able to drink milk further into their lives had a better chance of not starving to death before they procreated.
That adult mammals (including the other ape species) are covered in thick fur is also the norm, does that mean all humans are mutant freaks?
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My pharmacogenetics Prof. (yes, its not that new a field)explained it like this:
They had conducted a study which hinted that a whopping 40% of a population showed a genetic variety which renders a particular pharmaceutic more effective at treating a condition than any other. ...so they contacted the manufacturer and asked them if they were interested in conducting a prospective study.
well, they weren't. and why? because 40% of the population is not good enough, they want their product to be prescribed to ev
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Does it make sense to put much weight on this though?
Nowadays, somebody from Australia can travel to the other side of the planet and have children with somebody born there. Formerly some areas were very separate and would tend to have some consistency in the genetics, but thes
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Nowadays, the politically correct religion is the assertion that all ethnic groups and all racial groups are genetically identical.
I see you haven't read a newspaper in a while. Or even Googled [google.com] your absurd claims. Hell, you didn't even give it any thought; if it's true that it's taboo to study racial differences, than how do you know that Asians are lactose intolerant while Europeans are not?
Whoever modded you "insightful" needs to get another cup of coffee before doing any more moderations.
What about privacy concerns? (Score:2, Insightful)
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Insurance companies aren't the "wrong hands." If the information exists, it will either be used by insurance companies to establish fair prices or patients to buy "insurance" when they already know they're going to exercise it.
Insurance is gambling. You can't give one party (or any party) the right to change the bet or make the bet after the cards are revealed.
"pre-existing conditions" are only a problem because, for some reason, insurance isn't structured such that the insurer you had at the time of diag
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'Insurance companies aren't the "wrong hands."'
The US Congress (for example) begs to differ:
http://thomas.loc.gov/cgi-bin/bdquery/z?d110:HR00493:@@@L&summ2=m& [loc.gov]
Within the next decade, whole genome sequencing, which has already come down in price from several billion to $50,000 USD, is almost certainly going to become affordable enough to be used a a routine diagnostic procedure, enabling true personalised medicine (a '$1000 genome' is widely predicted). Do you think that filing your genome with an ins
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Insurance is gambling.
Running an insurance company is as much gambling as running a casino is. In other words: Not very much.
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That's what insurance is. What an Insurance Company provides, however, may be different than that - they are out to make a profit, not provide that cushion. With enough random people, statistics provide the ra
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Insurance IS gambling. Gambling is a good deal for the Casino because the risk is spread over a lot of bets, so the fact that the Casino's edge might be 51% means that make a steady, small percentage of a lot of money. Insurance is good for the insurance companies for the same reason. It's also good for those who make the bet with the insurance company because they trade a finite, small chance of catastrophic costs for a known, steady, affordable payment over time.
If genetic information were used to set insurance rates, I wouldn't have much problem with it.
Ironically, I would have a problem with
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Err ... when would that be? Insuring right after delivery is probably too late. Insuring right after conception is too late, too, since they could just use genetic information from the parents.
As interesting as the plan sounds, I don't think it's feasible.
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The only way I can see for the parents to have so many genetic disorders in common that it would raise the rate significantly above what others pay would be for the parents to be identical siblings.
Maybe in the future if there is one "super expensive" defect, we'll have to tweak the plan, but other than that, knowing the genetic information about the parents shouldn't give so much information that insurnace would be affordable for some and outrageous for others.
And as is the nature of probabilities, the mos
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It's not necessary for both parents to have those disorders (in fact, only few genetic disorders require this). A disorder can be x- or y-linked, or dominant.
In fact, both parents can be perfectly healthy and still have offspring with a genetic defect (e.g. colorblindness, which is x-linked. Women can have on
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Yes, but subsidizing an "insurer of last resort" for even fifteen million people is a lot less drastic than just taking over the entire industry.
Now, what's interesting is that there are a number of people who want to insure the uninsured with other people's money. If they really wanted to help the uninsured, they could create a fund right now with their own money to cover the costs of people who can't afford it.
People vote with their dollars for the things they really care about. Most people apparently
The Best Medications For Your Genes (Score:2)
Good Medications For Your may (or may not, at your option) include things like: food, beer, having a good time etc.
Unfortunately there is no obvious way of patenting that sort of thing in such a way as to be able to construct multi billion dollar corporations that have an uncanny knack of finding ways of getting government mandated things like the Medical Profession to cough up sums of money for problems that may or may not exist (since the existence questions must be legally sorted out by a Medical commun
I've seen this before somewhere... (Score:4, Insightful)
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GATTACA may happen if this becomes a situation where drugs that are effective on only certain genes become really cheap, and no suitable substitute is available for those whose genes do not permit good medication.
It's used to hide steroid use by athletes (Score:2)
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Tamoxifen has been used since at least 1990 to mask the use of anabolic steroids by athletes.
I think you've got that wrong, unless this is an additional use I'm not aware of. Tamoxifen citrate, more commonly referred to in these circles by its original trade name Nolvadex, is a potent SERM (Selective Estrogen Receptor Modulator) which steroid users commonly use when coming off-cycle during PCT (Post-Cycle Therapy.) While their natural testosterone production is recovering, SERMs help block a number of unwan
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No, don't have it wrong. I worked in a pharmacy back in the early '90s, and one of the weightlifters who got his steroids elsewhere (we wouldn't sell steroids to him, but syringes are available to everyone who wants under a government program that's intended to reduce needle sharing among druggies) was using tamoxifen to mask the steroids, and it worked. He always tested clean.
I thought it was funny because he came in a day after an interview with him made the local paper, where he said he didn't use st
Why Where and When? (Score:1, Flamebait)
Of course Forbes is known as a health care consumer advocate, not a source of data useful for strategic and tactical planning by corporations. Therefore they've put this article together so that we, the consumers, will seek the best possible care by consenting to the genetic testing offered, allowing them to select the best drugs for us rather than waste our time with less effective ones. There's no way any of those health care sources could misuse such information because the law forbids it, so when they s
Re:Why Where and When? (Score:5, Informative)
I'm not going to argue about the mysterious information you have, since you don't go into details on it, but as the author of the article, I should tell you that it's part of the "O'Reilly Insights" series, not a straightline Forbes piece, and I very much was writing it from the perspective of "here's a significant piece of medical advancement that will affect us as individuals, and is also going to make drastic changes in the pharma industry.
You say that there aren't enough drugs that genetic variance makes a difference in, and it's all a big scam to get people's data. Personally, I think that major differences in the effectiveness of the leading breast cancer drug, and huge variance in the uptake of the most commonly prescribed blood thinner, are pretty significant, and I'm damn glad I know that I overmetabolize Coumadin, because I could very well be in an ER with a stroke some day.
We're just in the very earliest stages of looking at how genetic variation affects medicine, and once we start to build a larger database of fully sequenced individuals, I'm sure we'll find more and more cases of genome-influenced variability.
And for the record, I'm an applicant to the Personal Genome Project, which is about as public a distribution of genomic information as you can get, so I am certainly putting my money where my mouth is as far as choosing the benefits of greater knowledge over the fear of discrimination.
Old news, but hey, it's news. (Score:4, Informative)
The FDA has had a table of valid genetic biomarkers for medications [fda.gov] for several years now. While many of these are cancer drugs looking at specific metatabolic or receptor issues, our old friend warfarin (a "blood thinner" with a narrow therapeutic index, a reputation for causing a lot of trouble and a genomic profile that accounts for about half of the known variation in the drug) and the pain drug codeine are on that list as well. There's even a research website [warfarindosing.org] devoted to genetic calculation of warfarin dosing.
Carbamazepine (Tegretol) can cause a rare life-threatening reaction called Stevens-Johnson Syndrome (Toxic Epidermal Necrolysis), but it's mostly limited to individuals with a specific Human Leukocyte Antigen (HLA-B*1502). Again, known for quite a while and a part of the basic biology of the drug.
It's a fairly well-written article, but it's kind of breathless about stuff that I was really excited about back in the '90's when my medical school teachers were really excited about it too. The best news is that the FDA has really stepped up in the past few years to make this actionable data that a practicing clinician can use.
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>>The FDA has had a table of valid genetic biomarkers for medications for several years now.
Yeah, exactly, this isn't really new news. When my wife started pharmacy school at UCSF in 2004, she took a class on pharmacogenetics, the study of how your genes affects how you interact with the drugs. CYP4, as TFA mentions, is one of the most important liver enzymes, but there's a lot of differences in populations due to genetics.
Alcohol Dehydrogenase and another liver enzyme (that I can't recall off the top
Mostly for cancer therapies only (Score:2)
Cuustom Meds (Score:3, Interesting)
Even more interesting - (Score:3, Informative)
From TFA:
There have also been a number of drugs under development, which were abandoned because they only benefited a small percentage of patients (say, for example, 30% of a hypothetical new drug), while carrying significant side effects. But just as those 10% of cancer patients got no benefit from tamoxifen because of a genetic variation, it might be the case that the 70% who didn't benefit from our hypothetical drug did so because they didn't have the correct genome. If we could identify the 30% that it worked for, what was once viewed as a failed drug could instead be a miracle drug, albeit for a subset of the entire patient population.
Imagine the research opportunities here. The R&D was done, the drug worked wonders in a small subset of patients and failed catastrophically in others... lets find out WHY. This idea could employ tens of thousands of researchers for several years just pouring over old trial data, running new trials, and linking genetic research to drug research.
I know if I were a pharma company I would be ramping up a similar effort. A good example is Elan's Tysabri, which was hailed as a wonder drug for many MS but faced major delays in light of a number of patients dying during trials... which nearly killed the company. A little genetic R&D and they may have been able to pinpoint those people who should not take the drug... allowing it to fly through FDA approvals.