The Humanwide Project: Pharmacogenomics

The Humanwide Project: Pharmacogenomics


It is day three, two days after my surgery. My
biggest fear was that I would have a bad reaction to the pain medication and I
have not had one. Pharmacogenomics which very simply
stated is the genetic influence on your drug response. What we envision in the
future and what we’re doing now, so the future is now, is measure your genetics
for the genetics that we know impact drugs in specific ways and
then figure out if drugs are likely to work for you or not work or should be as
expected. Humanwide is a pilot that we are conducting in a primary care clinic
in Santa Clara. We at that clinic have also implemented a team-based care model which we think is going to help us transform what we’re doing in primary
care. The focus of Humanwide is to consider how can we leverage the best of
the art and science of medicine that we have at Stanford and across the country
and the world — technology, genomics, diagnostics — how do we leverage that so
that we are focusing on prevention and proactive care to prevent disease before
it strikes. The issue that I have is that when I’m lying down in bed I can’t
breathe through my nose primarily because there’s not enough room in the
nasal passages and also because my nostrils collapse when I breathe in. The
surgery that I’m going to have will create more space inside the nasal
passages and will also strengthen the structure of the nostrils so that they
don’t collapse when I breathe. I take vitamin C, magnesium, vitamin D. And I take flax seed oil. We’re
going to start with this. This is a pharmacogenomics testing kit. So for this
kit we’re just going to collect some samples from your inner cheek. Pharmacogenomics is the study of how
your genetics, your ancestry, your parents your grandparents, how that affects your
response to drugs. Not everybody responds to drugs in the same way. But kind of
a natural idea. But why is that and it has to do with what you’re eating, what
diseases you have, but it has a big part to do with your genetic background. So,
how you respond to drugs is inherited just like many other things, like how
tall you are, what color your eyes are perhaps what diseases you might be at
risk for. So, what we want to do is we want to check people’s DNA and then give
them a report of which drugs are likely to work and which drugs they maybe
should stay away from because they’re either not going to work or the side
effects will not be tolerable.That’s in a nutshell what we’re trying to do,
predict drug response by making precise measurements of the genome. Hi. Good morning. Today is the fourth of
May. We plan to get out to go to Los Angeles for a few days. My blood pressure
is good. My heartburn much better because I changed my medicine. So,
everything is fine. Talk to you later. Eddie’s pharmacogenomics results were
remarkable for a couple of things. So, one was his cholesterol-lowering medication. We were able to have the dose of his statin which is significant because, for
Eddie, his primary medical concern is his low back pain and his muscle aches and we
do know that statins can cause muscle aches. Nice to see you, I’m Dr. Altman.
Welcome to the pharmacogenomics clinic. Thank you. In this clinic we’re
focusing on your response to drugs and we’ve learned that we can find small
differences in the DNA that might make you for example
metabolize a drug more quickly and get rid of it so it’s not actually in your
bloodstream as long as it might be for somebody else. Or it might work better
for you than for other people because of a little difference in your DNA. Well,
specifically I’m concerned about narcotic pain medications because I’m
gonna be having surgery and the surgeon has strongly recommended that I take
narcotic pain meds after my surgery for the pain. Have you had bad experiences
previously. Primarily I get really dizzy and disoriented, sort of drunk and high, and I don’t have any pain relief. So you’re
getting all the side effects but not any of the benefits. And then I itch. I itch
terribly all over. Very common. There might be even drugs that have not even
been released on the market yet that will be impacted by some of these
genetic differences and so it would be useful even going into the future to know about
your status for some of these enzymes. So the first one that
I’m going to highlight is this enzyme CYP2D6. So, you’re a slow metabolizer for
this enzyme but the important thing is that this enzyme is responsible for
metabolizing like 50 or 100 drugs. Which means right off the bat there are 50 or
100 drugs that I might recommend you get a lower dose of or less frequently
including some of these opioid narcotics that you were talking about. I think that
what we’ll recommend is opioid medications that don’t get metabolized
by this enzyme, so it’s totally taken off the table. Today is day five, Tuesday, my surgery was
on Friday. I’m not feeling very much pain right now. I didn’t have any of the foggy
headedness that I considered a negative side effect. If we can bring
pharmacogenomics to the front lines of medicine I think we have a better chance
of managing health instead of managing disease and so that’s where Precision
Health is a powerful idea, where we’re trying to keep people out of the system
by giving them the minimum medication at the right time and not have their
diseases progress, get worse, and become chronic diseases.

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