Taking the blinders off  pg. 5

“The key first step in searching for genetic variants that may increase susceptibility is finding enough patients who have suffered this unusual event,” Roden says. If genetic variants are found, it may be possible to develop diagnostic tests that can be used to identify in advance people at high risk for this side effect if they take certain drugs.

“What the human genome is teaching us is that there is tremendous variability among individuals at the genetic level … and that it ought to be possible to understand how that variability … in a whole set of genes might perturb responses in an individual or in a group of people to drugs.” —Dan M. Roden, M.D., director of the John A. Oates Institute for Experimental Therapeutics at Vanderbilt
Photo by Anne Rayner
Genetic testing is not an easy sell, however. “There are drugs for which there are potentially very effective genetic tests that can predict, with a high degree of probability, side effects,” Haas says. “But the companies that make those drugs are not pushing for genetic testing because they think… they will lose market share.

“Suppose there are three drugs for providers to choose from, and one of them shows that a genetic test will help you prescribe it better,” he explains. “Most clinicians right now would rather just write the prescription for the other drugs and avoid genetic testing.

“Genetics is not going to be used to guide prescribing just because it makes sense. It will only happen if accomplished, forward thinking investigators, in partnership with the community, really push this forward and make it a reality.”

William Evans, Pharm.D., director and chief executive officer of St. Jude Children’s Research Hospital in Memphis, agrees. Evans and his colleagues pioneered the use of genetic testing to improve treatment of childhood cancers.

“The burden is on us at academic medical centers to begin to not only provide… evidence that these genetic polymorphisms are influencing significantly the drug response,” Evans said during a lecture at Vanderbilt, “but to begin to incorporate that into treatment plans and protocols and to show… that it actually makes a difference.”

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