Slashdot Mirror
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.
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.
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/
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'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.
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.
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.