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The Best Medications For Your Genes
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.'"
getting denied health insurance for having bad genes
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.
How about placebos? I suspect they might work much better on some people than others.
They should have used git for version control.
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. Congress began deliberately funding the development of drugs that specifically help women.
The grip of religion on medicine has still not been broken. Nowadays, the politically correct religion is the assertion that all ethnic groups and all racial groups are genetically identical. Therefore, researchers should not study ethnic or racial differences in the efficacy of various drugs.
When will we admit that there are genetic differences? For example, most East Asians suffer from lactose intolerance. Europeans do not.
The current attempt to use a person's genes to determine the efficacy of anti-cancer drugs is a first step in breaking this politically correct religion.
That's why many countries have public health care. It's just simply fairer and better.
Say NO to unpaid Internships!
If drugs become targeted to certain DNA profiles, wouldn't it be likely that medical centers ask you to let them keep records of your DNA? Well, may be not your complete DNA, but certain genes. I wonder what could happen if such records go to the "wrong" hands, as health insurance companies.
I hate signatures
> When will we admit that there are genetic differences? For example, most East Asians suffer from lactose intolerance. Europeans do not.
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 breeds of humans just like there are breeds of dogs. The differences aren't as marked/significant as they are for dogs, but they are certainly there.
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 community that don't know enough about existential philosophy.)
John_Chalisque
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.
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 every single patient, regardless of the facts.
The problem is, you are, like soooo many before you, confusing significant cultural influence with some sort of inborn genetic trait: >so far none have done very well in the 100m sprinting event So you are saying that there is some "karate gene" then? What gene makes Americans poor at soccer while great at Basketball? The point is, certain cultures value certain sports more than others, and thus those sports attract the pool of athletes from a certain country. >And great influence in other fields such as finance. You realize that Jews were basically *forced* to be bankers for a large part of history right? Tax and interest collection as seen as Taboo for Christians, so they made the jews do it. Same thing with science: if you can get run out of town at a moments notice, you tend to value learning and intelligence, as those are things that pack easily.
... Oh yes; Gattaca.
Finally had enough. Come see us over at https://soylentnews.org/
Tamoxifen has been used since at least 1990 to mask the use of anabolic steroids by athletes.
> 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!
Genes do have a strong influence over intelligence. Just a few genetic differences can make a world of a difference. Chimpanzees are supposedly very similar to humans genetically, but they certainly have very different IQs.
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 saying it's _easy_, just less complex). Winning a karate championship on the other hand requires you to actively adapt to and anticipate other people's actions which can change in response and anticipation to yours. So it is likely to involve a lot more genes.
You could be born blind (faulty genes for that) and still win a world class 100 metre race, but if you're blind you'd have to be amazingly good in other areas to still beat sighted world-class opponents.
So the Jews that didn't value learning and intelligence died out? And so now more of them are smarter? Sounds like selective breeding to me. No doubt nurture plays a significant role in development, but they're more of "watering and feeding the plant". Given a reasonable environment, the plant you eventually get depends a lot on its genes.
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 these days with the easy availability of travel from anywhere to anywhere on the planet, genes are going to get mixed quite a lot.
IMO it doesn't make sense to classify people by race. If something like lactose intolerance matters for some purpose, then we should simply test the person for it, instead of making an assumption.
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 start ranking their drugs as to efficacy in various genotypes, they'll make it entirely our decision whether to pay for the best our insurance will allow us to have using shot in the dark medical treatment which would be considered experimentation on human subjects if it weren't so ingrained in our minds as acceptable medicine, or whether to request the genetic testing they make available as a service so they can help us select the most effective drug for us, something the insurance companies will be sure to support. And when the insurance companies decide it's time to raise the malpractice insurance rates again, those doctors who support genetic testing and use it to select medications will find that their policies will cost less if they take the precaution of testing their patients first rather than play Pharma roulette with their treatment.
Very, very few drugs do or can react differently enough according to the genetics to make it worth taking the trouble. But since a very few do, many will get tested. Whether or not there is a practical difference, a statistical difference can be forced making it seem as if more and more drugs can be dispensed according to this tactic. During the coming lobbyist/marketoid paroxysm of profit seeking wearing the Easter Bunny suit of consumer advocacy they enjoy so much, we will be bombarded with advertising (and the medical community with far more) showing us how this is all benefit to us, and care & concern on their part. Afterwards there will be genetics rankings on myriad products, and more and more treatment decisions will be based on these. There will be adequate statistical (as opposed to real) evidence supporting the use.
It will come from providers, and it will be our decision to accept it. They fully expect us to despite the fact this has been outlawed as long as it's their decision. There can be no huge FDA backlash because making them do an entire clinical series on the genetic aspect also will make drugs take even longer than the present too many years to get to market and cost yet another digit of price when they do. And when it is said and done, all medicine (after the gigantic increases in a few areas get smoothed out by filtering them through the industry) and treatment will cost more. How much more?
Enough to make up for what they'll lose in the coming health care 'reform' if they don't. This is, in effect, the health care industry acknowledging they lost the first battle in the war. They tried to say that prices and premiums would go up for the insured if this reform went through; they were called down on it since they are the one who set prices, making their statements essentially threats. That marketoid scheme backfired and cost them the battle. Now they're firing over our bow a tactic with which they can discredit as contrary to their stated purpose of saving consumer's money anyone who tries to stand between them and consumers, thereby forcing the appearance (at first) of alliance between them and consumers, stealing consumer hearts and minds back from the consumer advocacy groups and the few government officials that actually were trying to change things for the better. Once they're recaptured, re-enslaved and re-addicted enough consumers they can set this alternative plan in motion, and let the 'reform' go through. The alternative will allow them to make even greater profits within this new structure, polish their tarnished images in the public eye, forge new and reforge damaged bonds between themselves and key government agencies and
"I may be synthetic, but I'm not stupid." -- Bishop 341-B
The FDA has had a table of valid genetic biomarkers for medications 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 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.
> > I believe there are breeds of humans just like there are breeds of dogs.
> 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.
That may be the most inexplicable use of mod points I have ever seen.
(The parent is currently modded -1, redundant.)
It should be noted that this kind of "personalized medicine" as it tends to be called is mostly only relevant to cancer treatments that inhibit certain receptors or enzyme, as tamoxifen does. Typically there are cancer subtypes that, while they may look alike, are actually caused by a different mutation than the one that the anti-cancer drug targets.
BiDil comes to mind...
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 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.
Free Martian Whores!
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?
Free Martian Whores!
Where this will really come into its own is, down the road, where custom medications will be created specifically for your genetic profile. That is, they'll create a custom drug that fixes your problem but won't cause side-effects. This isn't tomorrow or 5 or 10 years from now, but more like 30-40 years from now. Creating a custom drug in a lab right now would be a major ordeal and very expensive, but with advances in biochemical modeling and automation, this can be overcome. By analyzing the genes, however, a custom drug can be developed that, not only works with your individual version of whatever proteins might be involved, but it can also be modeled against other genes/proteins to avoid potential side-effects, providing efficacious and side-effect free medication.
To some extent, personalized designer treatments are already being created. About a year ago I interviewed with a company specializing in this sort of thing: http://www.argostherapeutics.com/ . (Disclaimer: no, I didn't get the job, and no, I'm not plugging for the company). Basically what they were doing was taking a patient's cancer sample, breaking down the cells, and then electroporating the components into the patients FDCs (follicular dendritic cells). The FDCs are then reintroduced into the patient, and from there, present the antigens from the cancer sample and induce an immune response against them.
Basically it's a method to teach a person's immune system to attack their specific cancer. Functionally, it's closer to a therpeutic vaccine than a drug. As far as I know, this is the closest working example of personalized medicine we have.
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.
Sometimes the best solution is to stop wasting time looking for an easy solution.
You actually think any Roanoke Virginia doctors give a shit? You have got to be kidding me. The few glaring medical issues that have been keeping me from returning to work and they call them Electives, and keeping me in a revolving door staying disabled when I could return to work, so they can continue feeling like medical wonder gods and He-Man Physician of the Universes, and they're going to HELP ME? hahahahahahahaha So far I have cost the American taxpayers about $230,000.00 so these doctors wouldn't treat me successfully, and YOU knucklehead you think they will use this information? They aren't trying to heal people they keep people sick, keep people overweight, because it KEEPS THEM A STEADY WONDERFUL PAYCHECK. You're making me laugh so I thank you for that but sir, friend, whoever you are, you have a poor grasp of how the Commonwealth of Virginia operates as a communist outpost a take-off on Cuba. All we lack here is Fidel Castro and I expect him to arrive shortly. The lawyers operate as a communist bunch in cahoots with the physicians and hospital Board of Directors (ex railroad men) to always turn a profit and they back each other up if one makes a mistake the others cover it up by saying No, he made no mistake. hahahahahahahaha They even passed a Law that keeps any malpractice lawsuits from getting a fraction $$$$ of what the patient should receive. Damn, everybody here in Virginia knows the score and they know not to complain because it does no good, because complaining to an attorney who is in the doctor's back pocket achieves NOTHING. Welcome to Communist Virginia, and I advise you to stay the hell out of here, stay in a real state. Truck drivers should refuse loads into Virginia unless they get double pay, because if they are hurt here as I was they may as well eat a shotgun shell. A Monopoly exists here, a professional monopoly not a business monopoly, and you better learn that boy.
Industrial Age 2 + How-to Stop Malignant Cancers.