CRI Genetics

Here’s What Other Doctors Have Said About Pharmacogenomics...


Russ Atman, MD, PhD Stanford Medicine

“If we can bring pharmacogenomics to the frontlines of medicine, I think we have a better chance of managing health instead of managing disease.”

Pharmacogenomics—which, very simply stated—is the genetic influence on your drug response. What we envision in the future—and what we’re doing now—so, the future is now—is measure your genetics for the genetics we know impact drugs in specific ways and then figure out if drugs are likely to work for you or not work or should be as expected.

If we can bring pharmacogenomics to the frontlines of medicine, I think we have a better chance of managing health instead of managing disease.

Richard Weinshilboum, MD Mayo Clinic

“It’s an effort to individualize—to personalize—our use of drugs.”

Pharmacogenomics is just an attempt to use information from the Genome Project to help us understand why patients respond differently to drugs. Most patients will have the desired drug effect, but some will have severe adverse reactions and we want to avoid that… And at the other end of the spectrum, we want the drug to do what it’s supposed to do. We have good drugs available to treat heart disease, cancer in today’s world and we really want them to work, so it’s an effort to individualize—to personalize—our use of drugs.

We already have genomic tests, where we can look at slight differences within our genes that will help us to tailor the therapy of patients who are treated with one of the most commonly used blood thinners, anticoagulants in the country: Warfarin. Some people will need a very high dose of Warfarin, some people a much lower dose, and that’s because of our genes. 50% of the variation in the final dose of Warfarin is due to genetic variation in a couple of genes, which we can now determine in the laboratory.

  • https://www.youtube.com/watch?v=lMmYWgLMT-o&t=99s
  • https://www.mayo.edu/research/centers-programs/center-individualized-medicine/research/translational-programs/pharmacogenomics

Dr. Jerome Rotter, MD UCLA Medical Center

“The ultimate goal of personalized medicine is to come up with the right drug for the right patient at the right time.”

The idea of personalized medicine is that we’re coming to realize that individuals actually vary in their response to different drugs and therapies that are available provided by advances in medical knowledge… And the ultimate goal, therefore, of personalized medicine is to come up with the right drug for the right patient at the right time.

The most probably prescribed set of drugs today are called statins that lower what’s called the “bad” cholesterol (LDL cholesterol) and the reason they’re given, they’ve been shown absolutely that on average—notice the statement “on average”—they lower the cholesterol and they prevent the associated diseases we get from a high bad cholesterol. They reduce heart attacks. They reduce strokes. That’s been well-demonstrated and they’ve been a terrific addition to the therapies that physicians can give.

...But notice the statement I kept on saying “on average”... The reality is some people—on the therapeutic, or what’s called “efficacy” side, meaning how it acts—some people simply get no response to statins. It just doesn’t work for them. It doesn’t lower their bad cholesterol.

Furthermore, besides the good part of what a drug does, there’s something called “toxicity,” the bad part of what a drug does… And every drug, there is NO drug that does not have at least some chance of toxicity. Again, that’s an average statement. Some people, the risk is very great. Some people, the risk is simply not there.

Of course, what we want to do is give people the drugs that will work for them—that will be efficacious, that’s the term—and avoid the drugs that will be toxic.

Most of the diseases that affect people in the western world, that physicians take care of: heart disease, diabetes, gallstone disease, pulmonary disease… The vast majority of these diseases have a major genetic component, meaning that what you’ve gotten from your parents—that’s where you get your genes—has contributed to whether you are very susceptible to have that disease or very resistant.

There are different genes and they give you different forms of the disease. Those different forms of the disease are going to have different interactions with environmental factors, diet, exercise, things like smoking… Absolutely, there’s different interactions, in point of fact, even with lifestyle events. There are people coming to learn that you can adjust their diet and they respond and other people, adjusting the diet just doesn’t help.

The genes set you up an initial—if you will—tablet, initial slate, but you can actually modify that slate by a combination of interventions and part of personalized medicine is to know what intervention is appropriate for you.

You don’t treat all the same cholesterol the same. You don’t treat all the blood pressure the same. You don’t treat all the diabetes the same, but to individualize it, so that it will be most effective and hopefully, as we learn enough, that we can make it maximally effective from day one.

It’ll be the right drug for the right person. That’s the point. It’s for those people—in other words, that drug that’s supposed to do this effect on blood pressure—it’ll be the right drug and the people that will respond to it will be getting it. And if it comes up saying “drug is useless because of this and this lab test,” then a different class of drugs will be proposed.

It won’t be for all conditions in 10 years, but already I can tell you there are pilot projects around the nation that are doing this at a modest level.