Jun 11, 2014 4 min read

Commercials for prescription medications, with all their warnings of bad side effects, have become easy targets for standup comics.

The tendency is to poke fun at the drug, but what if the drug itself isn’t the culprit?

What if it’s your genes?

Pharmacogenomics is the word used to describe the field of study that looks at the influence of one’s genetic makeup on drug response. Specifically, 70 percent of all drugs are broken down by a specific enzyme pathway in the liver. By looking at the genetic differences in this pathway, health care practitioners can learn which specific drugs will work best for an individual when it comes to conditions like diabetes, clotting disorders, psychiatric disorders, pain management and more.

What may sound like science fiction is actually a field now so accessible that companies like McMurray’s Vista Healthcare Inc. are working to bring it to doctors’ offices nationwide.

“This technology tries to eliminate the trial and error of patient therapy that is pretty much standard in medicine,” said Braden Dernoshek, retail pharmacist and chief science officer for Vista Healthcare. “It’s one size fits all.”

You know the drill.

After receiving a new diagnosis at the doctor’s office, you’re told, “I’m going to prescribe ____. Try this, and let me know how it goes.”

The trial-and-error-ness of treatment is so embedded in our consciousness, that the word “try” doesn’t even get a moment’s attention, and, to some degree, neither do the 700,000 emergency room visits each year attributed to adverse medication events. But, pharmacogenomics or “personalized medicine” stands to correct those odds, with a swab of your cheek.

Tests involve swabbing the inside of the patient’s cheek to gather the cells whose DNA will be studied, with results available in just five to seven days.

This testing provides information not only about which medications will be most effective, but also the most effective doses. Terms like poor, rapid and ultrarapid metabolizer help physicians to choose doses of medications and predict side effects.

“We were having a lot of patients who were either having no response to some meds or exaggerated responses to some medications,” said Dr. Michael Toshok, a pain management anesthesiologist who works out of PainMed in the Mon Valley. “You wonder why, in some cases, a med that’s supposed to last eight to 10 hours only lasts two to three.”

Personalized medicine has unique implications for those with chronic pain. As Toshok explains, patients who were previously labeled as “drug seekers,” for insisting that they required more medication, may now be known as “ultra-rapid metabolizers” whose bodies use up the drug quicker than the average patient.

And, the technology may even help prevent some cases of addiction.

“If you continue to provide medication to someone who isn’t responding well,” said Toshok, “at some point the body no longer responds.

“They become tolerant and there is some physical dependency at some point in time.”

With the right information, however, there is the chance of eliminating poor responses to medication.

That’s right. Eliminating.

When it comes to personalized medicine, accuracy is not a problem.

As Dernoshek explains, it’s 100 percent accurate, and the only roadblock to widespread use is familiarity with the technology.

“I always equate it to an X-ray,” said Dernoshek, a Canon-McMillan High School graduate. “At one time, an X-ray was new and no one knew anything about it.

“But someone had to step up and make it the standard of care.”

Detractors might point to cost as a reason to avoid the use of this testing, but many insurance companies see it differently.

With reputable health care systems like Vanderbilt, Mayo Clinic and the University of Pittsburgh Medical Center establishing centers of personalized medicine, Medicare and many private insurance companies have calculated the cost of this genetic testing to be less expensive than the risk of adverse events.

Though fodder for comedians, medication side effects can be very serious, to include hemorrhage, respiratory depression and blood clots; side effects which may cost $5.6 million each year per hospital, according to two studies published in the Journal of the American Medical Association.

“It’s somewhat revolutionized the way that I practice,” said Toshok, “Because we have another tool to help us prescribe medications.”