Experts Push For Genetic Testing To Personalise Drug Prescriptions (theguardian.com) 27
Genetic testing to predict how individuals will respond to common medicines should be implemented without delay to reduce the risk of side-effects and ensure that everyone is given the right drug at the right dose, experts have said. From a report: About 6.5% of UK hospital admissions are caused by adverse drug reactions, while most prescription medicines only work on 30% to 50% of people. A significant part of this is due to genetics: almost 99% of people carry at least one genetic variation that affects their response to certain drugs, including commonly prescribed painkillers, heart disease drugs and antidepressants. By the age of 70, about 90% of people are taking at least one of these medications.
A new report, published by the British Pharmacological Society and the Royal College of Physicians, argues that many of these issues could be addressed through pharmacogenomic testing, which allows personalised prescribing according to people's genes. "The ultimate goal is to make pharmacogenomic prescribing a reality for everyone within the NHS, which will empower healthcare professionals to deliver better, more personalised care," said Sir Munir Pirmohamed, a professor of pharmacology and therapeutics at the University of Liverpool, who chaired the report's working party. "The aim of pharmacogenomics is to make sure patients get the right drug, at the right dose, at the right time to be able to improve their outcomes, treat their symptoms, cure their disease and prevent side-effects."
A new report, published by the British Pharmacological Society and the Royal College of Physicians, argues that many of these issues could be addressed through pharmacogenomic testing, which allows personalised prescribing according to people's genes. "The ultimate goal is to make pharmacogenomic prescribing a reality for everyone within the NHS, which will empower healthcare professionals to deliver better, more personalised care," said Sir Munir Pirmohamed, a professor of pharmacology and therapeutics at the University of Liverpool, who chaired the report's working party. "The aim of pharmacogenomics is to make sure patients get the right drug, at the right dose, at the right time to be able to improve their outcomes, treat their symptoms, cure their disease and prevent side-effects."
This will be difficult to do (Score:2)
In general, the way that drug trials are run will make this difficult to implement.
A drug generally is considered to work or not, given the sample size. On a subset of the study participants the drug worked great; it's just it's general effectiveness wasn't very good. At that point the drug is terminated.
To figure out why a drug works or doesn't work on a small subset of the population will be expensive. And separating the drug from the placebo effect will be difficult.
In a way, drug trials will need to cha
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No, this is already working, TGen Center for Rare Childhood Disorders [tgen.org] has been doing a version of this for years
They work with children who have disorders so rare that less then 10 cases occur globally. As a result no pharmaceutical company will take on the cost of developing new drugs
TGen does detailed genetic analysis and then runs comparisons to all currently available FDA approved medications to see if they can find one that can counter the genetic illness. Since these are already FDA approved, they are
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But those are medicines that have already undergone trials, and for rare but VERY well-defined medical issues. A lot of other disorders, diseases etc cover entire spectrums, and genetic compatibility might vary depending on race and even sex. So, as OP says, it'll be incredibly complex and easy to make errors.
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It may seem that way, what has been demonstrated with the rare childhood disorders is that going beyond the genetics to epigenetic analysis and the actual protein-some of the individual can FEQUENTLY identify an existing FDA approved material/drug (even nutriceuticals) that can provide relief to illness.
For example, take a look at FATTY-15 and type of butter fat with remarkable anti-aging properties [fatty15.com]
It does not always require creation of a new drug and the entire testing and human trials that go along with i
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At some point, well actually already to some extent, AI expert systems will be advanced enough to assist the doctor with asking the right questions, analyzing imaging, ordering the right tests, and making a diagnosis such that it will be very rare that errors are made.
Re:This will be difficult to do (Score:5, Interesting)
Incorrect. What's been missing from pharmacology for a long time is the mechanism of how these drugs work-- what activates them, and how they're removed from the system. In the last 20 years, huge strides have been made, including genetic markers.
For example, I'm immune to oxycodone, hydrocodone and codeine... I lack sufficient quantities of the enzyme CYP2D6 to activate these drugs. By the same token, a common beta-blocker that I take (cautiously), due to the low amount of this enzyme, it's very hard for my body to metabolize out of my system. The recommended dose for someone like me is one *quarter* the usual does-- otherwise, I can easily overdose on the drug. I discovered this the hard way, and that led me to research, and discover the "wonderful" world of cytochrome P450. It's estimated that about 60% of the drugs on the market affect me differently than a "normal" person. It's also estimated that about 10% of Caucasians in the USA have this particular issue.
On the other hand, my mother metabolizes these drugs out of her system so fast, there's not much point in giving them to her-- Most opiods affect her for less than 10 minutes. Similarly, due to an excess of CYP3A4, I metabolize caffeine at a ridiculous rate-- I can drink a bottle of Mt. Dew, and go to sleep an hour later. I've only had caffeine jitters once in my life-- after taking a drug that strongly inhibits that enzyme.
The sequences aren't totally understood-- my mother's markers for CYP2D6 are so rare, they don't know how to classify her, but the evidence supports "ultra rapid metabolizer" for those drugs. This affects anything from common OTC medications like acetaminophen, to anti-depressants, statins, blood thinners, and beta-blockers.
End result is that for any drug a doctor wants to prescribe, the first step is to look up how the drug functions, and how it's metabolized-- because in my family, that's very important information.
Re: This will be difficult to do (Score:2)
Some change will be required, but a lot of it will be in the data collection side, not the test protocol side. You would run the trial exactly like you do today, but also collect genetic data for all your participants. If the drug appears to have better than placebo average effect, you carry on with the normal process for getting the drug approved. In parallel though, you set computers crunching which genes the participants have in common for the group it worked for and the group it didnâ(TM)t work
And We Should Trust them With Our DNA Because? (Score:2)
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Wanting to stay alive and healthy could be one reason, though I suppose it is not for everyone.
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Pretty sure there would be no need to clone random people. Most people have any inflated sense of what their DNA is worth. Except maybe bc Olympic gold medalist or Nobel prize winners specifically.
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Testing for markers is not giving them your entire genome.
Giving blood samples, however, is. Think about that.
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Re: And We Should Trust them With Our DNA Because? (Score:2)
The only case I can see is that in America, insurance companies would be able to jack up your prices based on spotting genetic markers⦠but this article is talking about the UK, so no one there gives a shit about that.
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What can be tested for ? (Score:2)
> The ultimate goal is to make pharmacogenomic prescribing a reality for everyone ... to make sure patients get the right drug, at the right dose, at the right time to be able to improve their outcomes, treat their symptoms, cure their disease and prevent side-effects.
"Pharmacogenetic tests are only available for a limited number of medicines. Below are some of the medicines and genes that can be tested"
https://medlineplus.gov/lab-te... [medlineplus.gov]
Extended list:
"The table below lists therapeutic products from Drugs@
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That chart is reasonable, but what it doesn't demonstrate very well is how many drugs can be affected by a handful of enzymes-- CYP2D6 and CYP3A4 probably affect 60% of the drugs out there. Knowing the relative concentrations of P450 enzymes goes a long, long way towards understanding how the vast majority of drugs on the market will respond.
The real reason for this (Score:2)
Children and Psychiatric Drugs (Score:2)
It's helpful to a prescriber who has formed observational opinions about which drugs work better (or, most importantly, what is best tolerated).
I think that it's simple: testing labs should have no Pharm
Insurance companies will love this (Score:5, Insightful)
Don't get me wrong - medically and scientifically speaking this is a terrific development. And at my age and with my health issues I'm happy that it might save my life at some point. But from the "this is why we can't have nice things" department, the genetic data collected will inevitably be used to jack up insurance premiums of various kinds, or to deny coverage altogether.
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Yes, we are going to have to get the insurance companies out of medicine if we are going to have a working health care system. It is to their advantage to compromise the system in ways that maximize profit, so they are always working against efficiency.
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Yes, we are going to have to get the insurance companies out of medicine if we are going to have a working health care system. It is to their advantage to compromise the system in ways that maximize profit, so they are always working against efficiency.
True, but especially as I'm Canadian I wasn't thinking exclusively of health insurance. I can see personal genetic data having a big impact on life insurance, and possibly even car insurance, as well as homeowner and travel insurance.
Another thought occurred to me as I was writing this. What if it turns out that certain genetic makeups predispose us to certain behaviours, likes, and dislikes? Wouldn't advertisers salivate over that 'next level' of private personal data? And wouldn't the healthcare sector lo
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This will never work in the US healthcare system though.
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There's at least one major health organization in the US that offers pharmacogenomic testing, and enters that information into their EMR (electronic medical records) system, so that if an affected drug is prescribed, the doctor gets a warning that the drug may have unexpected effects.
The insurance company doesn't get this information, just the healthcare organization.
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The testing has to be specific. This isn't a broad sweep of "what diseases are you liable to have", this is a targeted analysis of your liver-- what can it metabolize, how much, and how fast?
So caution is needed, but everyone is acting like this is a total decode of your genome, and that's just ridiculous.
For now.