There’s been a lot more buzz lately around genetics at the consumer level. DNA kits that help sort out ancestry and many health concerns were packed under plenty of Christmas trees last year, and I’m sure that will repeat again.
But are we really doing anything with that information yet? There’s a certain novelty to it all, but for most people, does it really matter yet? Do you feel like it’s impacting your life yet?
That future is now.
When I applied to pharmacy school nearly a decade and half ago, I was sure that genetics were going to be a robust part of my pharmacy practice. Pharmacogenetics and pharmacogenomics felt like the buzz words to know.
In my application and interviews, I talked about how excited I was, looking forward to providing testing and helping patients determine optimal drug therapies for their genetic profiles.
It didn’t even seem far fetched that at some point “soon” we’d be creating individualized therapies for any number of diseases based on someone’s genetic profile.
But that hasn’t quite panned out has it?
The future I was imagining is here. And, as with flying cars, the future, at least for me, has turned out to be somewhat underwhelming.
Individualized therapies based on genetics are gaining foothold.
From a practical setting, individualized genetics and pharmacy have probably had the greatest partnership and success when it comes to cancer therapies.
Personalized cancer medicine, as it’s called, has allowed targeted therapies based on cancer types and subtypes as well as individual differences in bodily drug processing (pharmacogenomics).
Similar testing is becoming more common for certain psychiatric medications as well.
But why aren’t we seeing it in more places?
There probably is an answer to that, relating to money, but, this is more of a hypothetical question.
Let’s consider the number of Americans on cholesterol reducing drugs called statins, for example. They’re one of the most widely used drug categories in the country:
In 2012, the CDC estimated nearly 28% of American’s over 40 were on statins, with the numbers even higher for older folks and those with certain conditions.
By most measures however, statins are still widely underused. They are recommended for many based on many disease treatment guidelines, but actual use is less than would be recommended.
Why are statins underused?
Again, this is a complicated question.
As a pharmacist who has worked largely in the retail setting, I can tell you there is a lot of fear from customers about the perceived risks with statins.
Some of the most common concerns expressed to me are in regards to muscle pain and weakness or fatigue. And the risks are real, though most of the small number who develop problems can stop statins quite safely before any damage is done. Many physicians reinforce these concerns and tell patients that the statins may not be necessary.
Indeed, the “number needed to treat,” a measure of how many individuals need to be treated to prevent one bad outcome, in this case, death due to heart attack, or similar event, is fairly high. It’s easy to rationalize why you don’t need a statin. But who knows if you’re someone who really needs it or could skip it.
I know I can’t tell you that at the pharmacy counter.
Genetic testing and targeted therapies could improve compliance and safety and effectiveness.
In the case of statins, some research has been done regarding predicting the risk of heart attack and the potential benefit of statin therapy.
In this analysis of multiple other studies, which you can read more about here, researchers determined that they could classify patients into low, intermediate and high risk genetic categories for events such as heart attack, stroke or death related to coronary artery disease.
Those risk ratings also corresponded to a score predicting how likely a statin would be to reduce the risk of major events like heart attack or death. For the low risk group, statins only predicted to give a 13% reduction. But in the high risk group, risk was reduced by 48%.
Couple these findings with our knowledge of how genetics plays a part in metabolism and build up of statins in the system. We are familiar with a number of metabolizing enzymes and transporters that have genetic variability. Research indicates we can likely identify those at higher risk of toxicity due to statin buildup in the system, or perhaps, those in need of higher starting doses.
It seems to me that the ability to provide individualized therapy for something so commonly used as statins is out there.
When will individualized genetic based therapy take off?
Clearly, I have to scale back my expectations that pharmacies are going to look like apothecaries of old, but mixing up drugs for you, based on your genetics.
Compounding pharmacies are a niche, but their part in this will likely be in producing doses of drugs in non commercially available strengths to accommodate fine tuned dose requirements based on genetic testing.
And that would all be a step in the right direction. It seems the technology in at least a handful of cases is there.
The question I guess, is when will the costs make it worthwhile.
I’m holding out hope that I’ll see the wave of the future that was promised.
Your personal pharmacist
Part of why I’m waiting so excitedly for the future to get here is, I want to connect with patients.
Automation and technology keeps promising more time to serve the needs of our patients, and prove our worth as the most accessible healthcare providers.
Again, promises haven’t quite rung true. Instead of current technology freeing up more time for valuable patient interactions, the opposite seems to have happened. What I see frequently is further reduction in man hour and higher volume loads on increasingly stressed and isolated pharmacists.
Personally, I’m ready to get back to one on one relationships with patients. Relationships that can’t be side stepped when you sit down one on one for personally tailored to your genetics medication regimens.
And who better to do that with than your friendly, accessible pharmacist.
-Regina Moore, PharmD
Founder of The Pharmacist’s Slack
The Pharmacist’s Slack is a vetted, digital networking space for pharmacists across the country to easily connect, chat, and network.