By Joel Diamond, MD, Chief Medical Officer, Aranscia
LinkedIn: Joel Diamond
LinkedIn: Aranscia
Every hospital admission and every new prescription comes with a familiar routine: the insistent questions about medication allergies, often followed by a brightly colored wristband. This relentless focus on allergies aims to protect patients, and it’s certainly vital. According to an analysis conducted by the American Society of Pharmacovigilance (ASP), adverse drug events (ADEs) are now the third leading cause of death in the United States – surpassing even stroke and respiratory disease – yet only 5-10% of all adverse drug events are actually caused by true allergic responses. It is clear that healthcare organizations need a shift in focus.
The promise of personalized medicine is driven by insights hidden within our DNA. By understanding how a patient’s unique genetic code influences drug metabolism and action, healthcare providers can make more informed decisions, choosing the right medication at the right dose from the start. Studies indicate that more than 98% of people may have at least one genetic variant that could affect how they respond to commonly prescribed medications. Incorporating drug-gene testing (also known as pharmacogenomics, or PGx) into drug safety programs should be a mandate. The impact of this personalized approach is already becoming clear.
Medication safety extends beyond merely avoiding adverse reactions; it fundamentally encompasses ensuring that medications work effectively to achieve their intended therapeutic goals. A drug that causes no harm but provides no benefit is equally problematic. PGx is instrumental in optimizing both sides of this equation.
Consider clopidogrel, a vital antiplatelet medication used to prevent secondary cardiac events like heart attacks and strokes. Its efficacy is crucial for patient survival and quality of life. However, certain genetic variations can impair the body’s ability to convert clopidogrel into its active form, rendering it ineffective for some patients and leaving them vulnerable to life-threatening events. PGx testing can identify these individuals, allowing clinicians to choose an alternative, more effective antiplatelet therapy.
Furthermore, consider the current behavioral health crisis in the U.S. The trial-and-error approach to anti-depressant prescribing and the unconscionable time from diagnosis to treatment can be greatly reduced by adding PGx testing.
Recent studies suggest that approximately 60% of primary care patients are prescribed a medication with a pharmacogenomic recommendation. Other research has shown that a majority of patients were found to be taking medications that could have a PGx interaction in more than one clinical area. This highlights the widespread applicability and critical need for this personalized approach, affecting a majority of patients and multiple aspects of their care.
So, what’s taking so long? Despite their devastating impact, drug-related issues, particularly ADEs, are still largely overlooked in the broader healthcare landscape. Several factors contribute to this. Drug reactions are complex, often multifactorial, and can mimic symptoms of other diseases, making diagnosis challenging. Busy clinicians may not have the time to thoroughly investigate every potential drug interaction. And perhaps most significantly, PGx has not been a standard part of medical curricula, leading to a knowledge gap among many practitioners. Integrating PGx more thoroughly into medical, nursing, and pharmacy school curricula, as well as ongoing continuing education, should be paramount. And let’s not forget patient engagement. Empowering patients to understand their own genetic predispositions and participate actively in medication discussions is essential to a medical safety initiative.
While the potential of PGx is immense, it’s crucial to understand that it’s an enhancement to, not a replacement for, robust medication safety programs. Before integrating PGx, hospitals and clinics must have fundamental safety protocols in place. This includes clear medication reconciliation processes, standardized prescribing guidelines, robust drug interaction checking systems, and a culture that encourages reporting and learning from errors. PGx data is powerful, but its full benefit is realized when layered upon a strong foundation of existing safety practices that span the healthcare continuum.
For clinicians, PGx offers a powerful opportunity to adopt a “top-down” approach to prescribing. Instead of reacting to adverse events after they occur, doctors can proactively use genetic insights to avoid potentially harmful drug-gene interactions before writing a prescription. Robust integration into clinical workflows is essential. This is where modern Electronic Medical Record (EMR) systems play a pivotal role. Respecting the potential for “alert fatigue”, more intelligent warnings for known drug-gene or even a complex drug-drug-gene interaction can be employed at the point-of-prescribing.
These real-time alerts, powered by integrated PGx data, serve as invaluable clinical decision support tools. They can flag:
- Suboptimal drug efficacy: Suggesting an alternative medication or a higher dose due to rapid metabolism.
- Increased risk of adverse events: Recommending a different drug or a lower dose to avoid toxicity.
- Complex interactions: Highlighting how one medication might alter the metabolism of another, leading to unexpected drug levels.
The “test once, query often” model, coupled with intelligent EMR tools providing real-time drug-gene interaction alerts, promises to revolutionize how doctors prescribe and manage medications. This isn’t just about avoiding a yellow wristband; it’s about proactively protecting every patient, ensuring they receive the right drug, at the right dose, for their unique biological makeup. The era of one-size-fits-all medicine is giving way to a personalized, proactive approach where genetic insights become as fundamental as blood pressure readings. By embracing pharmacogenomics, investing in robust safety programs, and empowering clinicians with this vital knowledge, providers can move beyond merely mitigating risks to truly perfecting patient care.