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.