Eye color. Freckles. Tongue rolling. These are all observable physical traits determined by the 23 pairs of chromosomes our parents passed on to us, and these genes are the foundation and blueprints on which our bodies are formed. However, there are other biological factors, like drug metabolization, that are not as easily identified. A patient may slowly or rapidly metabolize certain drugs, leading to adverse reactions or no sign of drug effectiveness. ADRs (adverse drug reactions) are the fourth-leading cause of death in the United States. A widespread example occured in 2014 when the state of Hawaii filed a lawsuit against the manufacturer and distributor of Plavix due to large percentages of Pacific Islanders and East Asians experiencing negative side effects like gastrointestinal bleeding, despite manufacturer claims.
Physicians and pharmacists have a unique opportunity to work together and offer their patients pharmacogenetic testing, a DNA test that examines how an individual’s genes will respond to medications. After reading about pharmacogenomics in an article, Todd Troxell was driven to start his own pharmacy practice (Trox Pharmacy in Jacksonville, FL) and embrace innovative practices that sparked his curiosity. “When I was in pharmacy school,” Todd recounts, “I always wanted to know why a certain pill did what it did, where in the body it goes, how it works.” After becoming a pharmacist, Todd continued asking questions about medicine. “When I talked to physicians, I’d ask questions like why they would choose one SSRI over the other, and they would say that around 30% of people don’t respond to certain meds, but nobody knew why.” Now, with the data and research around pharmacogenomics, there is an explanation for the body’s response (or lack thereof) to specific drugs.
More healthcare professionals are embracing DNA testing as a proactive measure of patient care. Pharmacies wishing to guide future therapies through pharmacogenetic opportunities should review the recommended methods below.
In order to perform a pharmacogenetic test on a patient, he/she must be referred by a physician. Blair Thielemier, pharmacist and founder of Pharmapreneur Academy, suggests offering the test to physicians who are hesitant about pharmacogenomics. Blair says, “Let them experience it for themselves and share the results with them. That’s a good way to introduce it to someone who’s skeptical about it and not really sure how it can be clinically applicable.” Once prescribers understand how insightful these tests are, they will be more willing to refer patients who need pharmacogenetic testing.
When Todd discusses genetic testing with his patients, he emphasizes the long-term value of investing in the research. “Why risk an adverse drug reaction when you can test your genetics and find out whether or not you shouldn’t be taking a medication?” he points out. Genes never change, and the knowledge of a patient’s reaction to medications they currently take or could potentially take in the future may have a huge impact on their health outcomes.
Pharmacogenetic testing covers a wide range of medications, conditions, and genes. Targeting a specific population is a more efficient way to launch the practice. “I am a big fan of finding a niche to start working with. When I started my pharmacogenomics program, I really wanted to focus on children with ADHD or who were on antidepressants or anti-anxiety medications,” says Blair. When she first began her Genetic Consults website, Blair initially focused on parents who were trying to determine the right therapies for their children on psychoactive medicines. She even found a unique opportunity in her area when a local psychiatrist started requiring pharmacogenetic tests for all of his patients. Other popular niches for pharmacies include pain management and cardiovascular health.
For pharmacies that are exploring nutrition and functional medicine, areas like nutrigenomics may be of interest to them. Nutrigenomics, according to Environmental Health Perspectives, is “the study of the effects of nutrients on the expression of an individual’s genetic makeup.” Although new data and research are still emerging about nutrigenomics, Blair views it as an interesting way to offer health and wellness consults from the pharmacy.
Don’t play a guessing game with the success of your patients’ prescribed therapies. With pharmacogenomic testing, pharmacists and prescribers can avoid adverse drug reactions and proactively find medications that improve patient health.