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The ghost of personalized medicine

Drug therapies tailored to the DNA profiles of individual patients could change the face of medicine, but such treatments aren't commonly used in the clinic.

By | June 14, 2011

"Doctor's Visit" (detail)JAN STEEN

The US Food and Drug Administration recommends that doctors genotype patients before prescribing more than 70 commonly-used medications for specific genetic biomarkers. These tests, the agency suggests, can help physicians identify those in which the drug is less efficacious, poorly metabolized, or dangerous. But medicine is still far from a day when drugs and treatment regimes are fitted precisely to a patient's genomic profile.

According to a 2008 survey conducted by the American Medical Association (AMA) and Medco Research Institute, even though 98 percent of physicians agreed that the genetic profiles of their patients may influence drug therapy, only 10 percent believed they were adequately informed about how to test their patients for biomarkers that may predict the safety and/or efficacy of a particular drug.

"Less than 1 percent of all opportunities are being realized with respect to genetic testing," said Felix Frueh, president and head of genomics initiatives at Medco. "There's a long way until this new technology is going to see the translation."

Indeed, while new biomarkers are identified everyday, and researchers are continuing to collect more and more information about genetic variants that confer some amount of disease risk or predict a specific response to a treatment, that information has yet to be widely implemented in the clinic. The AMA states on its website that physicians today can use more than 1,200 genetic tests for more than 1,000 different diseases to help diagnose and treat their patients, but only 13 percent of the 10,000 doctors who responded to the survey had ordered a genetic test for a patient in the preceding 6 months.

But while physicians by in large have been slow to adopt the practice of screening patients to search for genetic information of relevance to drug treatments, known as pharmacogenomics, neither research nor regulation has stalled, as evidenced by the FDA's relabeling of dozens of approved drugs with biomarkers that affect their safety or efficacy in specific patient populations. "Pharmacogenomics is probably an area where personalized medicine is really able to deliver," Frueh said, "and it is able to do so because those are tests that can be clearly associated with a particular therapy."

In some cases, testing patients for the labeled pharmacogenomic markers has become critical. For example, the FDA strongly recommends that doctors prescribing the HIV drug abacavir test their patients for HLA-B*5701 allele. Individuals carrying that allele who take abacavir could become hypersensitive to the drug, which can lead to a systemic, potentially fatal flu-like illness. A 2008 study in the New England Journal of Medicine found that testing for the presence of HLA-B*5701 in HIV patients taking abacavir eliminated hypersentivity reactions. "Abacavir is a black and white example," Frueh said. "You know that if you don't do genetic testing, you're omitting something that's clearly a standard of care today."

"But," he added, "we have to be careful that we're not overstating what's possible." Other pharmacogenomic biomarkers, while helpful, aren't as cut-and-dried. Studies have yielded mixed results, for example, about whether genetic testing for different CYP2C19 alleles in patients taking the anticoagulant drug Plavix can indicate proper dosing schedules to improve how the drug is metabolized. Similarly, identifying single nucleotide polymorphisms in two genes, CYP2C9 and VKORC1, in patients taking another blood thinner, warfarin, can help guide optimum dosing to prevent over anticoagulation, but the markers' predictive ability varies widely across races, according to a 2008 Pharmacogenomics study.

Still, recent results suggest that genotyping patients who are receiving warfarin can improve health outcomes. A 2010 nationwide study that compared the effectiveness of warfarin among different patient populations, conducted by Medco and the Mayo Clinic of Rochester, Minnesota, found that patients receiving the drug who had been genotyped to determine their CYP2C9 and VKORC1 status were hospitalized about 30 percent less than patients whose genotypes were unknown. Remarkably, Frueh noted, only a handful of physicians out of the thousands contacted for the study were even aware that a genetic test existed that could potentially improve warfarin dosing in patients.

According to Vance Vanier, CEO of personal genetic analysis company Navigenics, this lack of implementation is one reason why personalized medicine is not yet a widespread clinical reality—a barrier that Vanier calls the "adoption gap" between advances in the lab and benefits in the clinic."The world is awash in biomarker content," Vanier said. "The key question is, 'What is the most effective mechanism to drive awareness among the primary care physician base?'"

Part of the problem, he suggested, is that physicians underestimate the predictive power of genetic risk factors for certain diseases or treatment outcomes. For example, he said that when he asks physicians in training to state the relative risks of classical predictors of heart disease, such as cigarette smoking or diabetes, he consistently hears figures like "10 to 15 times." In fact, Vanier said, most of those predictors only have relative risks of around 1.8 to 2 fold, similar to some of the more robustly linked genetic markers of disease or drug effectiveness. If doctors are made aware of the fact that certain genetic biomarkers can be just as powerful as traditional predictors, they may be more inclined to use them to help personalize treatment regimes.

Frueh agreed that there's a problem with clinical uptake of new genomic tools and biomarkers, adding that researchers also need to do a better job of demonstrating the clinical utility of such advances. "There is a paucity of data that we can point to and talk to physicians and practitioners about the clinical effectiveness of these tools," he said. "That has something to do with the lack of uptake as well."

Furthermore, with the sheer volume of new genomic information coming out of labs across the globe, it's difficult for physicians to stay abreast of the latest advances that could improve the way they treat their patients, Frueh said. "The 'build it and they will come' approach to personalized medicine is not going to work," he said. "If you're not actively reaching out to the people who are practicing, nobody is going to come."

Correction (June 14): The original version of this article included incorrect figures for the relative risks of traditional vs. genetic predictors of disease and/or drug effectiveness. The mistake has been corrected, and The Scientist regrets the error.

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Comments

Avatar of: Pete Kissinger

Anonymous

June 14, 2011

Genotype is fine, but phenotype is more real. Much could also be accomplished with more drug bioavailability monitoring that captures the impact of many transporters and metabolizing enzymes without having to profile them all. The genotype improves odds for efficacy (target availability), but determining actual drug concentrations deals with many other factors. This is becoming faster and will become more economic over time, particularly for oncology drugs.

Avatar of:

Posts: 0

June 14, 2011

Genotype is fine, but phenotype is more real. Much could also be accomplished with more drug bioavailability monitoring that captures the impact of many transporters and metabolizing enzymes without having to profile them all. The genotype improves odds for efficacy (target availability), but determining actual drug concentrations deals with many other factors. This is becoming faster and will become more economic over time, particularly for oncology drugs.

Avatar of:

Posts: 0

June 14, 2011

Genotype is fine, but phenotype is more real. Much could also be accomplished with more drug bioavailability monitoring that captures the impact of many transporters and metabolizing enzymes without having to profile them all. The genotype improves odds for efficacy (target availability), but determining actual drug concentrations deals with many other factors. This is becoming faster and will become more economic over time, particularly for oncology drugs.

Avatar of:

Posts: 0

June 15, 2011

In the age of decreasing health care costs, how does more testing decrease the cost?  Additionally, the cost of training lab personnel on the new testing technologies and the capitol expense for labs. Rural and small Urban areas will be a disadvantage. There is so much more complexity to issue than does it work.

Avatar of:

Posts: 0

June 15, 2011

In the age of decreasing health care costs, how does more testing decrease the cost?  Additionally, the cost of training lab personnel on the new testing technologies and the capitol expense for labs. Rural and small Urban areas will be a disadvantage. There is so much more complexity to issue than does it work.

Avatar of: David Paul

Anonymous

June 15, 2011

In the age of decreasing health care costs, how does more testing decrease the cost?  Additionally, the cost of training lab personnel on the new testing technologies and the capitol expense for labs. Rural and small Urban areas will be a disadvantage. There is so much more complexity to issue than does it work.

Avatar of: Norman Makous, M.D.

Anonymous

June 16, 2011

It should be emphazied that personal-zed medical care is individualized care but it should not be confused with personal medical care. The formed focuses on genetic markers to target diseases and care methods such as susceptibility to certain drugs. Personal medical care includes individual characteristics but also includes those important in care that are difficult to measure such as cultural background, likes and dislikes, views of health and disease and other biases. Personal-ized was a misapplied term that came into mis-uasge about ten years ago.

Norman Makous, M.D.

Avatar of:

Posts: 0

June 16, 2011

It should be emphazied that personal-zed medical care is individualized care but it should not be confused with personal medical care. The formed focuses on genetic markers to target diseases and care methods such as susceptibility to certain drugs. Personal medical care includes individual characteristics but also includes those important in care that are difficult to measure such as cultural background, likes and dislikes, views of health and disease and other biases. Personal-ized was a misapplied term that came into mis-uasge about ten years ago.

Norman Makous, M.D.

Avatar of: Leaps

Anonymous

June 16, 2011

From the evidence available for most of the mentioned genetic tests in this article, the question is not really uptake of genetic testing by physicians. But rather it is that there is no clear clinical utility for many of the genetic tests, i.e. does using the pharmacogenetic test produce a measurable improvement in health care for the typical patient. For tests for which the data are there, then uptake by physicians is generally quick. I think some education is needed for commercial test providers as to what data constitutes clinical utility, rather than wishful thinking.

Avatar of:

Posts: 0

June 16, 2011

From the evidence available for most of the mentioned genetic tests in this article, the question is not really uptake of genetic testing by physicians. But rather it is that there is no clear clinical utility for many of the genetic tests, i.e. does using the pharmacogenetic test produce a measurable improvement in health care for the typical patient. For tests for which the data are there, then uptake by physicians is generally quick. I think some education is needed for commercial test providers as to what data constitutes clinical utility, rather than wishful thinking.

Avatar of:

Posts: 0

June 16, 2011

From the evidence available for most of the mentioned genetic tests in this article, the question is not really uptake of genetic testing by physicians. But rather it is that there is no clear clinical utility for many of the genetic tests, i.e. does using the pharmacogenetic test produce a measurable improvement in health care for the typical patient. For tests for which the data are there, then uptake by physicians is generally quick. I think some education is needed for commercial test providers as to what data constitutes clinical utility, rather than wishful thinking.

Avatar of:

Posts: 0

June 16, 2011

It should be emphazied that personal-zed medical care is individualized care but it should not be confused with personal medical care. The formed focuses on genetic markers to target diseases and care methods such as susceptibility to certain drugs. Personal medical care includes individual characteristics but also includes those important in care that are difficult to measure such as cultural background, likes and dislikes, views of health and disease and other biases. Personal-ized was a misapplied term that came into mis-uasge about ten years ago.

Norman Makous, M.D.

Avatar of:

Posts: 0

June 19, 2011

So, if a relatively cheap, simple, one-time test can identify the, say, 60% of patients for whom a given drug does absolutely nothing (or is detrimental) for them given their genome and save them or their insurers thousands of dollars and/or chronic use of a worthless drug, uhm, I'll give another test. "But it's so complex, people, just keep buying and using worthless drugs."

Avatar of:

Posts: 0

June 19, 2011

So, if a relatively cheap, simple, one-time test can identify the, say, 60% of patients for whom a given drug does absolutely nothing (or is detrimental) for them given their genome and save them or their insurers thousands of dollars and/or chronic use of a worthless drug, uhm, I'll give another test. "But it's so complex, people, just keep buying and using worthless drugs."

Avatar of: SDK

Anonymous

June 19, 2011

So, if a relatively cheap, simple, one-time test can identify the, say, 60% of patients for whom a given drug does absolutely nothing (or is detrimental) for them given their genome and save them or their insurers thousands of dollars and/or chronic use of a worthless drug, uhm, I'll give another test. "But it's so complex, people, just keep buying and using worthless drugs."

Avatar of: Krszentivanyi

Anonymous

June 22, 2011

This is going to be one of the most powerful tool in the future treatment of the 'human individuals' whom should't be called patients any more

Avatar of:

Posts: 0

June 22, 2011

This is going to be one of the most powerful tool in the future treatment of the 'human individuals' whom should't be called patients any more

Avatar of:

Posts: 0

June 22, 2011

This is going to be one of the most powerful tool in the future treatment of the 'human individuals' whom should't be called patients any more

Avatar of:

Posts: 0

June 29, 2011

The problem is that patients have many genes that interact, so looking at only a few may be misleading. For example, the warfarin response may be affected by von Willebrand trait that could increase bleeding, or Factor V Leiden genes that diminish the clinical effect of the drug. Subjects in clinical trials don't usually have whole genomes sequenced for FDA approval or otherwise, because it's too expensive and hard to interpret. The cost of doing such studies may outweigh the cost savings of the drugs. This is why physician practitioners are not dummies and medicine is still an art.

Avatar of:

Posts: 0

June 29, 2011

This is a reply to Hbcr and the previous post by Pete.  You don't have to resequence, and its not that difficult to screen for a lot of things at once.  Microchip technology makes it possible to screen for literally hundreds of thousands of known alleles at one go, for less than the cost of an MRI.  What we are faced with is more just a question of adopting new technology; to realize the full benefit of the opportunity presented by this technology, we need a gestalt change, from the present perspective of treating individual diseases to a perspective of treating the whole patient.  Also, no one is going to be able to carry all of this in his head, so it will have to be computer-guided.  My opinion, this has to start in medical school and will take a generation to implement.  That said, I agree with Pete that genotype is not phenotype.  Genetics is not destiny, and genetic screening will never give us the whole picture.     

Avatar of:

Posts: 0

June 29, 2011

The problem is that patients have many genes that interact, so looking at only a few may be misleading. For example, the warfarin response may be affected by von Willebrand trait that could increase bleeding, or Factor V Leiden genes that diminish the clinical effect of the drug. Subjects in clinical trials don't usually have whole genomes sequenced for FDA approval or otherwise, because it's too expensive and hard to interpret. The cost of doing such studies may outweigh the cost savings of the drugs. This is why physician practitioners are not dummies and medicine is still an art.

Avatar of:

Posts: 0

June 29, 2011

This is a reply to Hbcr and the previous post by Pete.  You don't have to resequence, and its not that difficult to screen for a lot of things at once.  Microchip technology makes it possible to screen for literally hundreds of thousands of known alleles at one go, for less than the cost of an MRI.  What we are faced with is more just a question of adopting new technology; to realize the full benefit of the opportunity presented by this technology, we need a gestalt change, from the present perspective of treating individual diseases to a perspective of treating the whole patient.  Also, no one is going to be able to carry all of this in his head, so it will have to be computer-guided.  My opinion, this has to start in medical school and will take a generation to implement.  That said, I agree with Pete that genotype is not phenotype.  Genetics is not destiny, and genetic screening will never give us the whole picture.     

Avatar of: Hbcr

Anonymous

June 29, 2011

The problem is that patients have many genes that interact, so looking at only a few may be misleading. For example, the warfarin response may be affected by von Willebrand trait that could increase bleeding, or Factor V Leiden genes that diminish the clinical effect of the drug. Subjects in clinical trials don't usually have whole genomes sequenced for FDA approval or otherwise, because it's too expensive and hard to interpret. The cost of doing such studies may outweigh the cost savings of the drugs. This is why physician practitioners are not dummies and medicine is still an art.

Avatar of: Mightythor47

Anonymous

June 29, 2011

This is a reply to Hbcr and the previous post by Pete.  You don't have to resequence, and its not that difficult to screen for a lot of things at once.  Microchip technology makes it possible to screen for literally hundreds of thousands of known alleles at one go, for less than the cost of an MRI.  What we are faced with is more just a question of adopting new technology; to realize the full benefit of the opportunity presented by this technology, we need a gestalt change, from the present perspective of treating individual diseases to a perspective of treating the whole patient.  Also, no one is going to be able to carry all of this in his head, so it will have to be computer-guided.  My opinion, this has to start in medical school and will take a generation to implement.  That said, I agree with Pete that genotype is not phenotype.  Genetics is not destiny, and genetic screening will never give us the whole picture.     

Avatar of: Vetury Sitaramam

Anonymous

June 30, 2011

It appears that we need a new definition for evidence based medicine... the definition being that the cost incurred matches the benefit accrued. Chronic disease should be redefined as 'failure' of medicine and innovations in these are largely less than rewarding. US medical practices are, as the world over,  managed by emotional manipulation rather than in a public spirited manner. Genomics is catering to the top fraction of a percentage of public. This story hardly changes the picture.

Avatar of:

Posts: 0

June 30, 2011

It appears that we need a new definition for evidence based medicine... the definition being that the cost incurred matches the benefit accrued. Chronic disease should be redefined as 'failure' of medicine and innovations in these are largely less than rewarding. US medical practices are, as the world over,  managed by emotional manipulation rather than in a public spirited manner. Genomics is catering to the top fraction of a percentage of public. This story hardly changes the picture.

Avatar of:

Posts: 0

June 30, 2011

It appears that we need a new definition for evidence based medicine... the definition being that the cost incurred matches the benefit accrued. Chronic disease should be redefined as 'failure' of medicine and innovations in these are largely less than rewarding. US medical practices are, as the world over,  managed by emotional manipulation rather than in a public spirited manner. Genomics is catering to the top fraction of a percentage of public. This story hardly changes the picture.

Avatar of:

Posts: 0

July 5, 2011

I believe it's "by and large," not "by in large."

Avatar of:

Posts: 0

July 5, 2011

I believe it's "by and large," not "by in large."

Avatar of: Thatsnotmyname

Anonymous

July 5, 2011

I believe it's "by and large," not "by in large."

Avatar of: TheSciAdmin

TheSciAdmin

Posts: 56

July 6, 2011

Too right, Thatsnotmyname.

The phrase has been corrected.

Thanks for reading.

The Scientist

Avatar of:

Posts: 0

July 6, 2011

Too right, Thatsnotmyname.

The phrase has been corrected.

Thanks for reading.

The Scientist

Avatar of:

Posts: 0

July 6, 2011

Too right, Thatsnotmyname.

The phrase has been corrected.

Thanks for reading.

The Scientist

Avatar of:

Posts: 0

July 9, 2011

Personalized genomics has been available for some time to the consumers.  DNA Kits have diversified from offering paternity tests to offering scans for specific genetic markers.  How long before our smartphones come with the ability to scan our DNA?  Exciting times... 

Source:  www.dnakits.us

Avatar of:

Posts: 0

July 9, 2011

Personalized genomics has been available for some time to the consumers.  DNA Kits have diversified from offering paternity tests to offering scans for specific genetic markers.  How long before our smartphones come with the ability to scan our DNA?  Exciting times... 

Source:  www.dnakits.us

Avatar of: Rick Bartus

Rick Bartus

Posts: 1457

July 9, 2011

Personalized genomics has been available for some time to the consumers.  DNA Kits have diversified from offering paternity tests to offering scans for specific genetic markers.  How long before our smartphones come with the ability to scan our DNA?  Exciting times... 

Source:  www.dnakits.us

Avatar of: Sticky

Anonymous

July 19, 2011

This study seems quite old. Advances in this area are quite rapid so I'm sure if you repeated this study now the findings would be quite different.

Avatar of:

Posts: 0

July 19, 2011

This study seems quite old. Advances in this area are quite rapid so I'm sure if you repeated this study now the findings would be quite different.

Avatar of:

Posts: 0

July 19, 2011

This study seems quite old. Advances in this area are quite rapid so I'm sure if you repeated this study now the findings would be quite different.

Avatar of:

Posts: 0

July 20, 2011

Stephen Hawking makes a question in  A Brief History of
Time: "What is it that breathes fire into the
equations and makes a universe for them to describe?"

Did the scientist look
seriously about the electromagnetic envelope of the mitochondrial DNA?

Please, read the
paternal mtDNA heritage theory (ISBN 978-606-92107-1-0).

Abstract: The necessary and sufficient processes to a well
function of the human body are meticulous arranged by specific organizational
cells, so called process bio-managers, using interconditioned procedures,
transmitted through three ways of communication: chemical or “protein channelâ€쳌,
electrical or “ion channelâ€쳌 and mitochondrial or “EMF wireless channelâ€쳌. The
third type is out of the visible and measurable spectrum and raises a new
challenge to the scientist. For this type of bio communication we bring a new
theoretical hypothesis, based on the managerial multidisciplinary analysis of a
cybernetic model proposed by us, by simulating the human body function with the
virtual computerized system based on the management of its total knowledge and
its perfect quality way of function. The main bricks used for this virtual
construction are: the brain, as main bio-processor, and Eve mtDNA and Adam
mtDNA, as bio-antennas. This assembly of the total knowledge, build with “brain
reasoning, biological feeling, and unlimited soul feelingâ€쳌, is called by us
“main decision triangle, IQ-EQ-CQâ€쳌. The main principle of the management of the
total knowledge imposes us to not neglect the information produced by man
during the time, even if it seems creasy at the beginning (see brainstorming
definition). Because in the natural fertilisation the spermatozoids are
naturally equipped with the paternal mtDNA (it looks like reflex clystron power
amplifier, KPA = a veritable main bio-GPS), we consider that the paternal
mitochondria DNA have a very important role in the evolution of the human being
life quality and we have developed a new hypothesis, “Adam mtDNA theoryâ€쳌, in
addition to “Eve mtDNA theoryâ€쳌. Keywords: brain, mitochondria, maternal,
paternal
 

Avatar of:

Posts: 0

July 20, 2011

It took almost 3yrs. and six cardiologists to balance my medications after a near fatal MI and a diagnosis of CAD. My sensitivity and allegies were ignored, not one doctor to date has insisted I have any test that might predict my reactions; they all prefered that I react, and the reaction treated with more medication. I have avoided the universally recommended stent implantation because of my self-tested, and presumed sensitivity to stainless steel. Until the medical community considers quality of life as important as quantity of life, the impact of these advances will be minimallized as the body count remains the benchmark for success, medically and economically.

Avatar of:

Posts: 0

July 20, 2011

Truly personalized medicine would not only require the knowledge of the human genome, but also the genomes of the many symbiotic bacteria in the body.
 
It might be equally important for the personal pharmacist of the patient to also have access to a centralized database with the personal pharmacogenetic information.  It seems like this personal database service is a potential future business that could support doctors, pharmacists, and espceially emergency rooms.

Avatar of:

Posts: 0

July 20, 2011

Not mentioned in this article is the COMPLEXITY of the human genome. For a large number of "human complex diseases" (obesity, coronary heart disease, stroke, COPD, asthma, schizophrenia, Alzheimer disease, dementia, ADHD, autism spectrum disorder etc. etc.) if one determines the TOTAL CONTRIBUTION TO THE TRAIT---by all identified genes across the genomes that have a "highly statistically significant association" with that trait---the total contribution is between 6% and perhaps 40-60%. The remainder is contributed by what is being called "missing heritability", i.e. it appears not to be in the DNA sequence. Therefore, how can we predict which drug to prescribe and at which dose by any DNA sequence test (even a total genome-wide scan)? The answer is unequivocally that WE CANNOT.

Avatar of:

Posts: 0

July 20, 2011

Stephen Hawking makes a question in  A Brief History of
Time: "What is it that breathes fire into the
equations and makes a universe for them to describe?"

Did the scientist look
seriously about the electromagnetic envelope of the mitochondrial DNA?

Please, read the
paternal mtDNA heritage theory (ISBN 978-606-92107-1-0).

Abstract: The necessary and sufficient processes to a well
function of the human body are meticulous arranged by specific organizational
cells, so called process bio-managers, using interconditioned procedures,
transmitted through three ways of communication: chemical or “protein channelâ€쳌,
electrical or “ion channelâ€쳌 and mitochondrial or “EMF wireless channelâ€쳌. The
third type is out of the visible and measurable spectrum and raises a new
challenge to the scientist. For this type of bio communication we bring a new
theoretical hypothesis, based on the managerial multidisciplinary analysis of a
cybernetic model proposed by us, by simulating the human body function with the
virtual computerized system based on the management of its total knowledge and
its perfect quality way of function. The main bricks used for this virtual
construction are: the brain, as main bio-processor, and Eve mtDNA and Adam
mtDNA, as bio-antennas. This assembly of the total knowledge, build with “brain
reasoning, biological feeling, and unlimited soul feelingâ€쳌, is called by us
“main decision triangle, IQ-EQ-CQâ€쳌. The main principle of the management of the
total knowledge imposes us to not neglect the information produced by man
during the time, even if it seems creasy at the beginning (see brainstorming
definition). Because in the natural fertilisation the spermatozoids are
naturally equipped with the paternal mtDNA (it looks like reflex clystron power
amplifier, KPA = a veritable main bio-GPS), we consider that the paternal
mitochondria DNA have a very important role in the evolution of the human being
life quality and we have developed a new hypothesis, “Adam mtDNA theoryâ€쳌, in
addition to “Eve mtDNA theoryâ€쳌. Keywords: brain, mitochondria, maternal,
paternal
 

Avatar of:

Posts: 0

July 20, 2011

It took almost 3yrs. and six cardiologists to balance my medications after a near fatal MI and a diagnosis of CAD. My sensitivity and allegies were ignored, not one doctor to date has insisted I have any test that might predict my reactions; they all prefered that I react, and the reaction treated with more medication. I have avoided the universally recommended stent implantation because of my self-tested, and presumed sensitivity to stainless steel. Until the medical community considers quality of life as important as quantity of life, the impact of these advances will be minimallized as the body count remains the benchmark for success, medically and economically.

Avatar of:

Posts: 0

July 20, 2011

Truly personalized medicine would not only require the knowledge of the human genome, but also the genomes of the many symbiotic bacteria in the body.
 
It might be equally important for the personal pharmacist of the patient to also have access to a centralized database with the personal pharmacogenetic information.  It seems like this personal database service is a potential future business that could support doctors, pharmacists, and espceially emergency rooms.

Avatar of:

Posts: 0

July 20, 2011

Not mentioned in this article is the COMPLEXITY of the human genome. For a large number of "human complex diseases" (obesity, coronary heart disease, stroke, COPD, asthma, schizophrenia, Alzheimer disease, dementia, ADHD, autism spectrum disorder etc. etc.) if one determines the TOTAL CONTRIBUTION TO THE TRAIT---by all identified genes across the genomes that have a "highly statistically significant association" with that trait---the total contribution is between 6% and perhaps 40-60%. The remainder is contributed by what is being called "missing heritability", i.e. it appears not to be in the DNA sequence. Therefore, how can we predict which drug to prescribe and at which dose by any DNA sequence test (even a total genome-wide scan)? The answer is unequivocally that WE CANNOT.

Avatar of: Alexandru Boris Cosciug

Anonymous

July 20, 2011

Stephen Hawking makes a question in  A Brief History of
Time: "What is it that breathes fire into the
equations and makes a universe for them to describe?"

Did the scientist look
seriously about the electromagnetic envelope of the mitochondrial DNA?

Please, read the
paternal mtDNA heritage theory (ISBN 978-606-92107-1-0).

Abstract: The necessary and sufficient processes to a well
function of the human body are meticulous arranged by specific organizational
cells, so called process bio-managers, using interconditioned procedures,
transmitted through three ways of communication: chemical or “protein channelâ€쳌,
electrical or “ion channelâ€쳌 and mitochondrial or “EMF wireless channelâ€쳌. The
third type is out of the visible and measurable spectrum and raises a new
challenge to the scientist. For this type of bio communication we bring a new
theoretical hypothesis, based on the managerial multidisciplinary analysis of a
cybernetic model proposed by us, by simulating the human body function with the
virtual computerized system based on the management of its total knowledge and
its perfect quality way of function. The main bricks used for this virtual
construction are: the brain, as main bio-processor, and Eve mtDNA and Adam
mtDNA, as bio-antennas. This assembly of the total knowledge, build with “brain
reasoning, biological feeling, and unlimited soul feelingâ€쳌, is called by us
“main decision triangle, IQ-EQ-CQâ€쳌. The main principle of the management of the
total knowledge imposes us to not neglect the information produced by man
during the time, even if it seems creasy at the beginning (see brainstorming
definition). Because in the natural fertilisation the spermatozoids are
naturally equipped with the paternal mtDNA (it looks like reflex clystron power
amplifier, KPA = a veritable main bio-GPS), we consider that the paternal
mitochondria DNA have a very important role in the evolution of the human being
life quality and we have developed a new hypothesis, “Adam mtDNA theoryâ€쳌, in
addition to “Eve mtDNA theoryâ€쳌. Keywords: brain, mitochondria, maternal,
paternal
 

Avatar of: Slick

Anonymous

July 20, 2011

It took almost 3yrs. and six cardiologists to balance my medications after a near fatal MI and a diagnosis of CAD. My sensitivity and allegies were ignored, not one doctor to date has insisted I have any test that might predict my reactions; they all prefered that I react, and the reaction treated with more medication. I have avoided the universally recommended stent implantation because of my self-tested, and presumed sensitivity to stainless steel. Until the medical community considers quality of life as important as quantity of life, the impact of these advances will be minimallized as the body count remains the benchmark for success, medically and economically.

Avatar of: cireader

cireader

Posts: 18

July 20, 2011

Truly personalized medicine would not only require the knowledge of the human genome, but also the genomes of the many symbiotic bacteria in the body.
 
It might be equally important for the personal pharmacist of the patient to also have access to a centralized database with the personal pharmacogenetic information.  It seems like this personal database service is a potential future business that could support doctors, pharmacists, and espceially emergency rooms.

Avatar of: Daniel W Nebert, MD

Anonymous

July 20, 2011

Not mentioned in this article is the COMPLEXITY of the human genome. For a large number of "human complex diseases" (obesity, coronary heart disease, stroke, COPD, asthma, schizophrenia, Alzheimer disease, dementia, ADHD, autism spectrum disorder etc. etc.) if one determines the TOTAL CONTRIBUTION TO THE TRAIT---by all identified genes across the genomes that have a "highly statistically significant association" with that trait---the total contribution is between 6% and perhaps 40-60%. The remainder is contributed by what is being called "missing heritability", i.e. it appears not to be in the DNA sequence. Therefore, how can we predict which drug to prescribe and at which dose by any DNA sequence test (even a total genome-wide scan)? The answer is unequivocally that WE CANNOT.

Avatar of: yeruham

yeruham

Posts: 9

July 20, 2011

I highly agree with Dr Makous about personal medical care. I have two points to add: 1. Many medical doctors are not going to like what I am about to say but it has been known in Asian medicine for centuries that the same treatment will not necessarily work for different types of people. This is true of Chinese, Tibetan and Indian Ayurvedic medicine, for example. I know the most about the latter so I'll comment on that. Ancient Indian Ayurvedic medicine, uses its own diagnostic methods to classify people into various types and combinations thereof. This classification is the basis of the treatment, which usually includes dietary and behavioral advice as well as herbal medicine and sometimes massage and other physical treatments. There may also be correlations between Ayurvedic doshas (the bases of their typing) and genotypes. Bhushan Patwardhan of the Interdisciplinary School of Health Sciences, University of Pune, has written quite a bit on this. See:
http://www.iaim.edu.in/pdf/JAC... 
for example.
I suspect that Ayurveda and other Asian systems of  medicine, and today's pharmacogenetics could benefit from mutual cooperation.
2. As for the failure of MDs to make clinical use of what is known in pharmacogenetics, I would say that it is the job of the medical schools to do more to teach it. Of course that is easier said than done in today's packed medical curricula.
Frank J. Leavitt ("Yeruham") PhD
Senior Lecturer Emeritus,
Ben Gurion University
Beer Sheva, Israel.

Avatar of:

Posts: 0

July 20, 2011

I highly agree with Dr Makous about personal medical care. I have two points to add: 1. Many medical doctors are not going to like what I am about to say but it has been known in Asian medicine for centuries that the same treatment will not necessarily work for different types of people. This is true of Chinese, Tibetan and Indian Ayurvedic medicine, for example. I know the most about the latter so I'll comment on that. Ancient Indian Ayurvedic medicine, uses its own diagnostic methods to classify people into various types and combinations thereof. This classification is the basis of the treatment, which usually includes dietary and behavioral advice as well as herbal medicine and sometimes massage and other physical treatments. There may also be correlations between Ayurvedic doshas (the bases of their typing) and genotypes. Bhushan Patwardhan of the Interdisciplinary School of Health Sciences, University of Pune, has written quite a bit on this. See:
http://www.iaim.edu.in/pdf/JAC... 
for example.
I suspect that Ayurveda and other Asian systems of  medicine, and today's pharmacogenetics could benefit from mutual cooperation.
2. As for the failure of MDs to make clinical use of what is known in pharmacogenetics, I would say that it is the job of the medical schools to do more to teach it. Of course that is easier said than done in today's packed medical curricula.
Frank J. Leavitt ("Yeruham") PhD
Senior Lecturer Emeritus,
Ben Gurion University
Beer Sheva, Israel.

Avatar of:

Posts: 0

July 20, 2011

I highly agree with Dr Makous about personal medical care. I have two points to add: 1. Many medical doctors are not going to like what I am about to say but it has been known in Asian medicine for centuries that the same treatment will not necessarily work for different types of people. This is true of Chinese, Tibetan and Indian Ayurvedic medicine, for example. I know the most about the latter so I'll comment on that. Ancient Indian Ayurvedic medicine, uses its own diagnostic methods to classify people into various types and combinations thereof. This classification is the basis of the treatment, which usually includes dietary and behavioral advice as well as herbal medicine and sometimes massage and other physical treatments. There may also be correlations between Ayurvedic doshas (the bases of their typing) and genotypes. Bhushan Patwardhan of the Interdisciplinary School of Health Sciences, University of Pune, has written quite a bit on this. See:
http://www.iaim.edu.in/pdf/JAC... 
for example.
I suspect that Ayurveda and other Asian systems of  medicine, and today's pharmacogenetics could benefit from mutual cooperation.
2. As for the failure of MDs to make clinical use of what is known in pharmacogenetics, I would say that it is the job of the medical schools to do more to teach it. Of course that is easier said than done in today's packed medical curricula.
Frank J. Leavitt ("Yeruham") PhD
Senior Lecturer Emeritus,
Ben Gurion University
Beer Sheva, Israel.

Avatar of: Sureshkhandige

Anonymous

July 23, 2011

Genetics is not the only story, what is worse is that it is not
the environment either. The fact is that the partnership between the genetics
and environment begins very early on, since the conception of the very first
cell and we will have a long, very long indeed, struggle dealing with these realities
on our hands. We are dealing with, literally, a mega-scaled enormity of genetics
at conception (that carries its own knowledge of the world around) interacting all
along, as things progress, with equally mega-scaled enormity of environment (to
which, to some extent, the genetics is prepared to respond very well for the
sake of maintain continuity), interacting all along, to produce the organism at
present, regardless of the age. Tough job on our hands, literally worthy of our
genuine strengths and efforts, it will radically change our understanding and
practice of medicine of body and mind altogether.

Avatar of:

Posts: 0

July 23, 2011

Genetics is not the only story, what is worse is that it is not
the environment either. The fact is that the partnership between the genetics
and environment begins very early on, since the conception of the very first
cell and we will have a long, very long indeed, struggle dealing with these realities
on our hands. We are dealing with, literally, a mega-scaled enormity of genetics
at conception (that carries its own knowledge of the world around) interacting all
along, as things progress, with equally mega-scaled enormity of environment (to
which, to some extent, the genetics is prepared to respond very well for the
sake of maintain continuity), interacting all along, to produce the organism at
present, regardless of the age. Tough job on our hands, literally worthy of our
genuine strengths and efforts, it will radically change our understanding and
practice of medicine of body and mind altogether.

Avatar of:

Posts: 0

July 23, 2011

Genetics is not the only story, what is worse is that it is not
the environment either. The fact is that the partnership between the genetics
and environment begins very early on, since the conception of the very first
cell and we will have a long, very long indeed, struggle dealing with these realities
on our hands. We are dealing with, literally, a mega-scaled enormity of genetics
at conception (that carries its own knowledge of the world around) interacting all
along, as things progress, with equally mega-scaled enormity of environment (to
which, to some extent, the genetics is prepared to respond very well for the
sake of maintain continuity), interacting all along, to produce the organism at
present, regardless of the age. Tough job on our hands, literally worthy of our
genuine strengths and efforts, it will radically change our understanding and
practice of medicine of body and mind altogether.

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