Medicare outpatients billed more for some procedures

A new government report finds Medicare and its beneficiaries "may be paying differently for similar care”

From: http://www.cbsnews.com/news/medicare-outpatients-risk-higher-bills-for-some-procedures/

Mayo Clinic - Session 2: Evening Powered by PechaKucha: Jen van der Meer

From: Mayo Clinic http://www.youtube.com/watch?v=vv5H6iEmkpE

Mayo Clinic - Session 1: Make Change Possible: George C. Halvorson

From: Mayo Clinic http://www.youtube.com/watch?v=gvLYYY4UfBY

Lab adapts toys for children with disabilities

The Adaptive Toy Project is helping to make toys more accessible so disabled kids can play with them, too

From: http://www.cbsnews.com/news/adaptive-toy-project-lab-adapts-toys-for-disabled-children/

Why some teens skip treatment for sexual health issues

A new report reveals how many teens are afraid their parents will find out if they go for reproductive health care

From: http://www.cbsnews.com/news/privacy-reason-teens-dont-seek-reproductive-sexual-medical-health-care/

Mayo Clinic - Session 1: Make Change Possible: Karen Watson

From: Mayo Clinic http://www.youtube.com/watch?v=f6sShsgALrQ

Mayo Clinic - Session 1: Make Change Possible: Will Steger

From: Mayo Clinic http://www.youtube.com/watch?v=gDzVkWBrQGY

Tips for a Healthy Holiday Season – Celiac Disease in the News

From: Mayo Clinic http://www.youtube.com/watch?v=JroOwq1vB1o

Pain Relievers May Be Tied to Hearing Loss in Some

But degree of impairment tied to acetaminophen and ibuprofen was modest, researchers say

From: http://www.webmd.com/pain-management/news/20161219/everyday-pain-relievers-may-be-linked-to-hearing-loss-in-some-women?src=RSS_PUBLIC

Cochlear Implants

From: Mayo Clinic http://www.youtube.com/watch?v=RVqFtDoyh18

Vestibular Schwannoma

From: Mayo Clinic http://www.youtube.com/watch?v=scaHl42LhBo

Vitamin D: What’s the “right” level?

Many of my patients who come into the office for their physical exams ask to have their vitamin D levels checked. They may have a family member with osteoporosis, or perhaps they have had bone thinning themselves. Mostly, they want to know that they’re doing everything they can to keep their bones strong. Vitamin D is critical for healthy bones. But when we check that blood level, how to act on the result is the subject of great controversy in medical-research land.

Pinpointing a “healthy” vitamin D level is tricky

So, what is the current cutoff value at which people are considered “low,” and thus at risk for developing bone thinning and having fractures? (We are talking about the blood level of 25-hydroxy-vitamin D, which is usually measured in nanograms per milliliter.) Ah. This is where there is a lot of argument.

In 2010, the venerable Institute of Medicine (IOM) issued a report based on lengthy examination of data by a group of experts. To sum up, they estimated that a vitamin D level of 20 ng/mL or higher was adequate for good bone health, and subsequently a level below 20 was considered a vitamin D deficiency.

In my practice, and in most, it is not uncommon to see a vitamin D level less than 20. When that happens, we tell the patient that they are deficient and recommend fairly aggressive replenishment, as well as ongoing supplementation. The majority of folks have a level between 20 and 40, in my experience, and this is corroborated by the IOM’s findings in that 2010 report.

But in 2011, the respected Endocrine Society issued a report urging a much, much higher minimum blood level of vitamin D. The society’s clinical practice guideline was developed by experts in the field assigned to a Vitamin D Task Force, and they concluded: “Based on all the evidence, at a minimum, we recommend vitamin D levels of 30 ng/mL, and because of the vagaries of some of the assays, to guarantee sufficiency, we recommend between 40 and 60 ng/mL for both children and adults.”

But wait, there’s more…

The most recent opinion on the right target level of vitamin D is presented in an article titled “Vitamin D Deficiency: Is There Really a Pandemic?” published in the New England Journal of Medicine. In this piece, several of the leading epidemiologists and endocrinologists who were on the original IOM committee argue for a lowering of the currently accepted cutoff level of 20, stating that the level they estimated as acceptable was never intended to be used to define vitamin D deficiency. They feel that we are overscreening for vitamin D deficiency, and unnecessarily treating individuals who are perfectly fine.

Based on their analysis, a more appropriate cutoff for vitamin D deficiency would be much lower, 12.5 ng/mL. They examined a massive amount of data from the National Health and Nutrition Examination Survey (NHANES) for 2007 through 2010, and found that less than 6% of Americans had vitamin D levels less than 12.5. A cutoff of 12.5 ng/mL would most certainly eliminate the “pandemic” of vitamin D deficiency.

And the controversy boils on, with many articles and statements made to support one or the other guideline.

Some perspective on what is, and isn’t, vitamin D deficiency

I spoke with osteoporosis expert Dr. Joel Finkelstein, associate director of the Bone Density Center at Massachusetts General Hospital, whose research in this field spans over three decades. He agreed with the authors of the NEJM article that we are currently overscreening for vitamin D deficiency, and overtreating people who are getting enough vitamin D through diet and sun exposure. “Vitamin D has been hyped massively,” he states. “We do not need to be checking the vitamin D levels of most healthy individuals.”

He points out that from an evolutionary standpoint, it doesn’t make sense that higher vitamin D levels would be beneficial to humans. “Vitamin D is actually quite hard to find in naturally occurring food sources,” he points out. “Yes, we can get vitamin D from the sun, but our bodies evolved to create darker skin in the parts of the world that get the most sun. If vitamin D is so critical to humans, why would we evolve in this way, to require something that is hard to come by, and then evolve in such a way as to make it harder to absorb?”

So who should be screened for vitamin D deficiency?

Dr. Finkelstein and his colleagues recently published a study of over 2,000 perimenopausal women who had been followed for almost 10 years, and they found that vitamin D levels less than 20 were associated with a slightly increased risk of nontraumatic fractures. They concluded that because few foods contain vitamin D, vitamin D supplementation is warranted in women at midlife with levels less than 20 ng/mL. “For perimenopausal women or other groups of people with higher fracture risk, certainly a level of 20 or above is ideal,” and he adds: “For the vast majority of healthy individuals, levels much lower, 15, maybe 10, are probably perfectly fine, and so I would say I agree with what the authors of the New England Journal perspective article are saying.”

All that said, most experts, including Dr. Finkelstein, agree we should be checking vitamin D levels in high-risk people — those most at risk for a true deficiency. These include people with anorexia nervosa, people who have had gastric bypass surgeries, who suffer from other malabsorption syndromes like celiac sprue, or who have dark skin, or wear total skin covering (and thus absorb less sunlight). In addition, certain populations will require that vitamin D level of 20 ng/ml or higher. This can include perimenopausal women, people diagnosed with osteopenia (reduced bone density, but not osteoporosis) and osteoporosis or other skeletal disorders, as well as pregnant and lactating women. All of these groups should be screened and treated as appropriate.

__________________________________________

JoAnn E. Manson, M.D., Dr.P.H., Patsy M. Brannon, Ph.D., R.D., Clifford J. Rosen, M.D., and Christine L. Taylor, Ph.D. Vitamin D Deficiency — Is There Really a Pandemic? New England Journal of Medicine

Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism 2011

Heaney RP, Holick MF. Why the IOM recommendations for vitamin D are deficient. Journal of Bone and Mineral Research

Bouillon R, Van Schoor NM, Gielen E, et al. Optimal vitamin D status: A critical analysis on the basis of evidence-based medicine. Journal of Clinical Endocrinology & Metabolism.

Cauley JA, Greendale GA, Ruppert K, Lian Y, Randolph JF Jr, Lo JC, Burnett-Bowie SA, Finkelstein JS. Serum 25 hydroxyvitamin D, bone mineral density and fracture risk across the menopause. Journal of Clinical Endocrinology & Metabolism, May 2015.

The post Vitamin D: What’s the “right” level? appeared first on Harvard Health Blog.

From: Monique Tello, MD, MPH http://www.health.harvard.edu/blog/vitamin-d-whats-right-level-2016121910893

Pregnancy brain changes may prep women for motherhood

A new study found differences in MRI brain scans that could reveal if women were pregnant or not

From: http://www.cbsnews.com/news/pregnancy-brain-changes-may-prepare-women-for-motherhood-new-baby/

More U.S. women using pot during pregnancy

Though the actual numbers are small, the trend raises concerns because of evidence linking marijuana use during pregnancy to fetal health problems

From: http://www.cbsnews.com/news/marijuana-and-pregnancy-more-us-women-using-pot-while-pregnant/

Female Doctors May Have an Edge

Older hospital patients treated by a woman were slightly less likely to be readmitted or die within 30 days

From: http://www.webmd.com/healthy-aging/news/20161219/female-doctors-may-have-an-edge-study?src=RSS_PUBLIC

Pot Use in Pregnancy on the Upswing, Study Finds

Researchers concerned about possible harm to fetus

From: http://www.webmd.com/baby/news/20161219/pot-use-in-pregnancy-on-the-upswing-study-finds?src=RSS_PUBLIC

Dr Pritish Tosh discusses germs on kitchen sponges

From: Mayo Clinic http://www.youtube.com/watch?v=lJJ02jY2wEw

Black Box Warnings Removed From Chantix, Zyban

Black Box Warnings Removed From Chantix, Zyban

From: http://www.webmd.com/smoking-cessation/news/20161219/black-box-warning-chantix-zyban?src=RSS_PUBLIC

E-Cigs Can Trigger Lifelong Addiction in Kids

American Academy of Pediatricians' report says the earlier kids 'vape,' the more likely they're hooked

From: http://www.webmd.com/smoking-cessation/news/20161219/nicotine-in-e-cigs-can-trigger-lifelong-addiction-in-kids-docs?src=RSS_PUBLIC

Henry Heimlich, 'Heimlich Maneuver' Inventor, Dies

Henry Heimlich, 'Heimlich Maneuver' Inventor, Dies

From: http://www.webmd.com/a-to-z-guides/news/20161217/heimlich-maneuver-inventor-dies?src=RSS_PUBLIC

Flu Season's Starting to Rear Its Head

It's not too late to get your flu shot, health officials say

From: http://www.webmd.com/cold-and-flu/news/20161216/flu-seasons-starting-to-rear-its-head?src=RSS_PUBLIC

Chemo More Damaging to Hearts of Diabetics

Those with blood sugar disease showed more early warning signs of heart failure

From: http://www.webmd.com/cancer/news/20161216/chemo-more-damaging-to-hearts-of-diabetics-study?src=RSS_PUBLIC

Flu season is here, say health officials

Flu season is hitting some states harder than others right now, but it's not too late to get your flu shot

From: http://www.cbsnews.com/news/flu-season-is-here-in-us-not-too-late-for-flu-shot-vaccine/

Nicotine in e-cigs can trigger lifelong addiction in kids

Doctors warn that the earlier kids "vape," the more likely they are to get hooked

From: http://www.cbsnews.com/news/nicotine-in-e-cigs-can-trigger-lifelong-addiction-in-kids/

Are male or female doctors better for patients?

A new study finds hospital patients treated by women doctors did better when it came to two important health outcomes

From: http://www.cbsnews.com/news/women-doctors-hospital-patients-fare-better-study/

Troubling Trend: Depression Rates Rising in Teens

This story looks at the reasons why rates of depression are rising in teens.

From: http://www.webmd.com/depression/news/20161219/depression-rates-rising-teens?src=RSS_PUBLIC

Vitamin D: What’s the “right” level?

Many of my patients who come into the office for their physical exams ask to have their vitamin D levels checked. They may have a family member with osteoporosis, or perhaps they have had bone thinning themselves. Mostly, they want to know that they’re doing everything they can to keep their bones strong. Vitamin D is critical for healthy bones. But when we check that blood level, how to act on the result is the subject of great controversy in medical-research land.

Pinpointing a “healthy” vitamin D level is tricky

So, what is the current cutoff value at which people are considered “low,” and thus at risk for developing bone thinning and having fractures? (We are talking about the blood level of 25-hydroxy-vitamin D, which is usually measured in nanograms per milliliter.) Ah. This is where there is a lot of argument.

In 2010, the venerable Institute of Medicine (IOM) issued a report based on lengthy examination of data by a group of experts. To sum up, they estimated that a vitamin D level of 20 ng/mL or higher was adequate for good bone health, and subsequently a level below 20 was considered a vitamin D deficiency.

In my practice, and in most, it is not uncommon to see a vitamin D level less than 20. When that happens, we tell the patient that they are deficient and recommend fairly aggressive replenishment, as well as ongoing supplementation. The majority of folks have a level between 20 and 40, in my experience, and this is corroborated by the IOM’s findings in that 2010 report.

But in 2011, the respected Endocrine Society issued a report urging a much, much higher minimum blood level of vitamin D. The society’s clinical practice guideline was developed by experts in the field assigned to a Vitamin D Task Force, and they concluded: “Based on all the evidence, at a minimum, we recommend vitamin D levels of 30 ng/mL, and because of the vagaries of some of the assays, to guarantee sufficiency, we recommend between 40 and 60 ng/mL for both children and adults.”

But wait, there’s more…

The most recent opinion on the right target level of vitamin D is presented in an article titled “Vitamin D Deficiency: Is There Really a Pandemic?” published in the New England Journal of Medicine. In this piece, several of the leading epidemiologists and endocrinologists who were on the original IOM committee argue for a lowering of the currently accepted cutoff level of 20, stating that the level they estimated as acceptable was never intended to be used to define vitamin D deficiency. They feel that we are overscreening for vitamin D deficiency, and unnecessarily treating individuals who are perfectly fine.

Based on their analysis, a more appropriate cutoff for vitamin D deficiency would be much lower, 12.5 ng/mL. They examined a massive amount of data from the National Health and Nutrition Examination Survey (NHANES) for 2007 through 2010, and found that less than 6% of Americans had vitamin D levels less than 12.5. A cutoff of 12.5 ng/mL would most certainly eliminate the “pandemic” of vitamin D deficiency.

And the controversy boils on, with many articles and statements made to support one or the other guideline.

Some perspective on what is, and isn’t, vitamin D deficiency

I spoke with osteoporosis expert Dr. Joel Finkelstein, associate director of the Bone Density Center at Massachusetts General Hospital, whose research in this field spans over three decades. He agreed with the authors of the NEJM article that we are currently overscreening for vitamin D deficiency, and overtreating people who are getting enough vitamin D through diet and sun exposure. “Vitamin D has been hyped massively,” he states. “We do not need to be checking the vitamin D levels of most healthy individuals.”

He points out that from an evolutionary standpoint, it doesn’t make sense that higher vitamin D levels would be beneficial to humans. “Vitamin D is actually quite hard to find in naturally occurring food sources,” he points out. “Yes, we can get vitamin D from the sun, but our bodies evolved to create darker skin in the parts of the world that get the most sun. If vitamin D is so critical to humans, why would we evolve in this way, to require something that is hard to come by, and then evolve in such a way as to make it harder to absorb?”

So who should be screened for vitamin D deficiency?

Dr. Finkelstein and his colleagues recently published a study of over 2,000 perimenopausal women who had been followed for almost 10 years, and they found that vitamin D levels less than 20 were associated with a slightly increased risk of nontraumatic fractures. They concluded that because few foods contain vitamin D, vitamin D supplementation is warranted in women at midlife with levels less than 20 ng/mL. “For perimenopausal women or other groups of people with higher fracture risk, certainly a level of 20 or above is ideal,” and he adds: “For the vast majority of healthy individuals, levels much lower, 15, maybe 10, are probably perfectly fine, and so I would say I agree with what the authors of the New England Journal perspective article are saying.”

All that said, most experts, including Dr. Finkelstein, agree we should be checking vitamin D levels in high-risk people — those most at risk for a true deficiency. These include people with anorexia nervosa, people who have had gastric bypass surgeries, who suffer from other malabsorption syndromes like celiac sprue, or who have dark skin, or wear total skin covering (and thus absorb less sunlight). In addition, certain populations will require that vitamin D level of 20 ng/ml or higher. This can include perimenopausal women, people diagnosed with osteopenia (reduced bone density, but not osteoporosis) and osteoporosis or other skeletal disorders, as well as pregnant and lactating women. All of these groups should be screened and treated as appropriate.

__________________________________________

JoAnn E. Manson, M.D., Dr.P.H., Patsy M. Brannon, Ph.D., R.D., Clifford J. Rosen, M.D., and Christine L. Taylor, Ph.D. Vitamin D Deficiency — Is There Really a Pandemic? New England Journal of Medicine

Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism 2011

Heaney RP, Holick MF. Why the IOM recommendations for vitamin D are deficient. Journal of Bone and Mineral Research

Bouillon R, Van Schoor NM, Gielen E, et al. Optimal vitamin D status: A critical analysis on the basis of evidence-based medicine. Journal of Clinical Endocrinology & Metabolism.

Cauley JA, Greendale GA, Ruppert K, Lian Y, Randolph JF Jr, Lo JC, Burnett-Bowie SA, Finkelstein JS. Serum 25 hydroxyvitamin D, bone mineral density and fracture risk across the menopause. Journal of Clinical Endocrinology & Metabolism, May 2015.

The post Vitamin D: What’s the “right” level? appeared first on Harvard Health Blog.

From: Monique Tello, MD, MPH http://www.health.harvard.edu/blog/vitamin-d-whats-right-level-2016121910893

HPI brief: U.S. dental spending sees uptick in 2015

Dental spending again increased in 2015, an indication that the dental economy is rebounding from a flat trend that began in the Great Recession, according to the ADA Health Policy Institute.

From: http://www.ada.org/en/publications/ada-news/2016-archive/december/hpi-brief-us-dental-spending-sees-uptick-in-2015

Can genetic testing help determine the best medications for you?

The saying “if it seems too good to be true, it likely is” applies to so many things in life. As the director of the Clinical Pharmacogenomics Service at Boston Children’s Hospital, I spend a significant amount of time discussing what pharmacogenomics testing cannot tell us. I am sure you are wondering why I would take a negative approach instead of touting the miracles of pharmacogenomics testing, since after all, that is my job. Well, as with many things, it is complicated.

Pharmacogenomics can potentially guide drug choices

Pharmacogenomics is the study of gene expression on the ability to metabolize or break down medications. The term “gene expression” is important because we’re talking about how much your genes influence your response to a medication. Much like the director of a play or movie, your genes give instructions to other parts of your body. One of the things your genes direct is the production of enzymes required to break down (or “metabolize”) the drugs you take. These enzymes influence how effective a drug might be for you and how likely you are to experience negative side effects. Your unique combination of genes is called your genotype. Your genotype can tell us if you will make more or significantly less enzyme than other people. These enzymes help break down the medications into substances that can be more easily excreted by the body. However, in some cases these substances can be active and some are even harmful before they are excreted. This partially explains why some people will get no effect at all while others end up in the hospital with severe side effects from the same medication at the same dose.

Many factors affect how you metabolize medications, including your age, gender, diet, whether or not you smoke, whether or not you are pregnant, your other medical problems, and very importantly, the other medications you are taking (including over-the-counter medications and herbal supplements). I often use the analogy of a pie to describe the effect of genetics on a medication’s metabolism. In some cases, your genetics makes up a very large part of the pie — up to 90% for some medications. In other cases, your genetics are only a tiny sliver of the pie and the other factors make up the largest amount.

Using pharmacogenomics wisely is key to its usefulness

The key to applying pharmacogenomics is knowing when to test and how to apply the results. There are several situations where genetic testing before starting a medication is standard of care today. When there is a well-understood drug-gene interaction, knowing the genotype before starting treatment can avoid dangerous side effects. An example of this is a medication for the treatment of inflammatory bowel disease that, if metabolized slowly, can lead to a severely depressed immune system and life-threatening infections. In other cases, knowing that a patient will not respond to a therapy can save precious time and protect quality of life, such as for certain cystic fibrosis and cancer medications. As always, the goal is to match the right drug to the right patient to achieve the greatest benefit with minimal side effects.

Pharmacogenomic testing can be informative and can help caregivers and patients make safer decisions when choosing medications. However, promoting pharmacogenomic testing with application to only one disease state or with questionable testing practices can cause more harm than good. Most genes influence how the body metabolizes not just one class of medications, but can influence many other drug classes as well, and to different degrees. Focusing only on one condition, such as ADHD, and ignoring the influence that genotype may have on other drug classes, such as medications for heart disease, can actually result in patient harm. Overstating the impact of the genotype on the person’s ability to metabolize medications can also cause serious anxiety. Patients have reported feeling scared to take any medications, even when they know that their condition will not likely get better without treatment.

And this is why during each visit, we spend a significant amount of time discussing what pharmacogenomics cannot tell us. And then we talk about whether testing might make sense. For patients who have had a long history of serious side effects from various medications or failure to respond to medication, testing can help explain what has gone on in the past as well as help guide future decisions. In one memorable case, the patient was extremely grateful for results that explained why she had experienced debilitating insomnia while on fluoxetine. She told us that previous healthcare providers had told her it was “all in her head” when actually it was her inability to metabolize the drug at standard doses. For others, results predicting and thus avoiding life-threatening reactions to anti-epileptic drugs help design a more appropriate regimen for seizure control.

While the science of pharmacogenomics has been around for a hundred years, we are still at just the tip of the iceberg in understanding that information and using it to improve the lives of patients. There has been an explosion of knowledge over the past 10 years and we learn new things every day. It is an exciting time to be studying pharmacogenomics!

The post Can genetic testing help determine the best medications for you? appeared first on Harvard Health Blog.

From: Shannon Manzi, PharmD http://www.health.harvard.edu/blog/can-genetic-testing-help-determine-the-best-medications-for-you-2016121610888

ADA asks new administration to consider several regulations for reform in 2017

In a letter to President-Elect Donald Trump and Vice President-Elect Mike Pence, the ADA is asking the new administration to consider several health care regulations for regulatory reform in 2017.

From: http://www.ada.org/en/publications/ada-news/2016-archive/december/ada-asks-new-administration-to-consider-several-regulations

WHO: Urgent medical shipments to Aleppo, Syria

From: World Health Organization http://www.youtube.com/watch?v=cgpOqbsU2lM

Sitting at your desk doesn’t have to be a pain in the neck

From: http://www.mayoclinic.com/sitting-at-your-desk-doesnt-have-to-be-a-pain-in-the-neck/art-20269947

Biopsy: Types of biopsy procedures used to diagnose cancer

From: http://www.mayoclinic.com/diseases-conditions/cancer/in-depth/biopsy/art-20043922

Antidepressants: Get tips to cope with side effects

Most antidepressant side effects aren't dangerous, but they can be bothersome. Here's what to do.

From: http://www.mayoclinic.com/diseases-conditions/depression/in-depth/antidepressants/art-20049305

Blood glucose meter: How to choose

From: http://www.mayoclinic.com/diseases-conditions/diabetes/in-depth/blood-glucose-meter/art-20046335

Can genetic testing help determine the best medications for you?

The saying “if it seems too good to be true, it likely is” applies to so many things in life. As the director of the Clinical Pharmacogenomics Service at Boston Children’s Hospital, I spend a significant amount of time discussing what pharmacogenomics testing cannot tell us. I am sure you are wondering why I would take a negative approach instead of touting the miracles of pharmacogenomics testing, since after all, that is my job. Well, as with many things, it is complicated.

Pharmacogenomics can potentially guide drug choices

Pharmacogenomics is the study of gene expression on the ability to metabolize or break down medications. The term “gene expression” is important because we’re talking about how much your genes influence your response to a medication. Much like the director of a play or movie, your genes give instructions to other parts of your body. One of the things your genes direct is the production of enzymes required to break down (or “metabolize”) the drugs you take. These enzymes influence how effective a drug might be for you and how likely you are to experience negative side effects. Your unique combination of genes is called your genotype. Your genotype can tell us if you will make more or significantly less enzyme than other people. These enzymes help break down the medications into substances that can be more easily excreted by the body. However, in some cases these substances can be active and some are even harmful before they are excreted. This partially explains why some people will get no effect at all while others end up in the hospital with severe side effects from the same medication at the same dose.

Many factors affect how you metabolize medications, including your age, gender, diet, whether or not you smoke, whether or not you are pregnant, your other medical problems, and very importantly, the other medications you are taking (including over-the-counter medications and herbal supplements). I often use the analogy of a pie to describe the effect of genetics on a medication’s metabolism. In some cases, your genetics makes up a very large part of the pie — up to 90% for some medications. In other cases, your genetics are only a tiny sliver of the pie and the other factors make up the largest amount.

Using pharmacogenomics wisely is key to its usefulness

The key to applying pharmacogenomics is knowing when to test and how to apply the results. There are several situations where genetic testing before starting a medication is standard of care today. When there is a well-understood drug-gene interaction, knowing the genotype before starting treatment can avoid dangerous side effects. An example of this is a medication for the treatment of inflammatory bowel disease that, if metabolized slowly, can lead to a severely depressed immune system and life-threatening infections. In other cases, knowing that a patient will not respond to a therapy can save precious time and protect quality of life, such as for certain cystic fibrosis and cancer medications. As always, the goal is to match the right drug to the right patient to achieve the greatest benefit with minimal side effects.

Pharmacogenomic testing can be informative and can help caregivers and patients make safer decisions when choosing medications. However, promoting pharmacogenomic testing with application to only one disease state or with questionable testing practices can cause more harm than good. Most genes influence how the body metabolizes not just one class of medications, but can influence many other drug classes as well, and to different degrees. Focusing only on one condition, such as ADHD, and ignoring the influence that genotype may have on other drug classes, such as medications for heart disease, can actually result in patient harm. Overstating the impact of the genotype on the person’s ability to metabolize medications can also cause serious anxiety. Patients have reported feeling scared to take any medications, even when they know that their condition will not likely get better without treatment.

And this is why during each visit, we spend a significant amount of time discussing what pharmacogenomics cannot tell us. And then we talk about whether testing might make sense. For patients who have had a long history of serious side effects from various medications or failure to respond to medication, testing can help explain what has gone on in the past as well as help guide future decisions. In one memorable case, the patient was extremely grateful for results that explained why she had experienced debilitating insomnia while on fluoxetine. She told us that previous healthcare providers had told her it was “all in her head” when actually it was her inability to metabolize the drug at standard doses. For others, results predicting and thus avoiding life-threatening reactions to anti-epileptic drugs help design a more appropriate regimen for seizure control.

While the science of pharmacogenomics has been around for a hundred years, we are still at just the tip of the iceberg in understanding that information and using it to improve the lives of patients. There has been an explosion of knowledge over the past 10 years and we learn new things every day. It is an exciting time to be studying pharmacogenomics!

The post Can genetic testing help determine the best medications for you? appeared first on Harvard Health Blog.

From: Shannon Manzi, PharmD http://www.health.harvard.edu/blog/can-genetic-testing-help-determine-the-best-medications-for-you-2016121610888