Which drug is best? There’s a test
Winters had always been rough for Diane Smith.
Since her mom died a decade ago, they’ve been all but unbearable. Her depression would get progressively worse until the anniversary of her mother’s death: Valentine’s Day.
This year — its heavy snowfall forcing her to shovel constantly — was shaping up to be particularly bad. But, somehow, the despair never came.
“I would have been hospitalized at that point because I would have been so despondent,” said the 61-year-old Bend resident, “and I just got through it miraculously.”
Last spring, her doctor performed a test that turned up a genetic mutation he believes was making her antidepressant less effective. He put her on a supplement designed to augment the medication.
A plethora of tests exist that identify, usually through a mouth swab, whether patients’ unique genetic makeups affect how well specific medications work for them and whether they could produce dangerous side effects. This emerging sector of medicine is called pharmacogenetics, or pharmacogenomics. Although it’s been slow to catch on among medical providers, research on the subject is robust.
More than 100 Food and Drug Administration- approved medications list relevant genetic factors that could affect their safety or effectiveness. The FDA lists on its website more than 200 genetic biomarkers and drug pairings and their potential consequences for patients.
Dr. Richard MacDonell, Smith’s doctor and a primary care physician in Bend who offers pharmacogenetic testing, said traditional medicine works by trial-and-error: You take patients through several different types of medications for their condition, tweak the dose here and there, until you find one that works without terrible side effects. The process can take months. A look at their genetic makeup, however, can narrow things down much faster.
“The question is, ‘Can we be smarter about it and tailor it instead of just shotgunning?’” MacDonell said.
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