Personalized Prescribing: Making the Most of Medicare Preventive Services

Many people don’t realize that personalized prescribing based on DNA testing is covered by most public and private insurers if a healthcare provider believes it is medically necessary. Be sure to ask about personalized prescribing at your next annual wellness visit.

Medicare offers a number of preventive services, including a free annual wellness visit so your doctor can identify health risk factors and recommend steps you can take to reduce those risks. Your doctor will evaluate your personal and family medical history, as well as current medications, and order tests. (See page 3 for complete description.) The goal of these visits is to prevent disease and to improve your overall health and well-being.

More and more physicians are including medication risk assessments to identify drug side-effects and interactions that may be causing problems along with the standard risk assessments for depression, heart disease, and cancer. If you’re taking four or more prescription drugs or one, such as Plavix, with a warning about genetics on the label, your doctor may order DNA Drug Sensitivity Testing to help optimize your prescriptions. Typically covered by insurance if ordered by a qualified healthcare provider, personalized prescribing helps doctors determine both “drug-to-drug” and “drug-to-DNA” interaction risk.

The comprehensive personalized prescribing program analyzes all the prescription drugs, herbal preparations, and over-the-counter medicines patients are taking for their combined interaction risk, and for their compatibility with a patient’s unique DNA profile.

“With this tool, no longer is it a trial and error proposition as to what drug and dose to prescribe; we can now do it scientifically with a much better outcome for the patient.”

- J.E. Block, MD, FACP, Tulsa, Oklahoma

As the number of drugs an individual is taking goes up, so do the risks of a serious or even fatal reaction. If these drugs are being prescribed by more than one doctor, are self-prescribed, such as herbals, or purchased from more than one source, the risks go up even more.

A questionnaire is now available that allows patients to quickly calculate their risk for adverse drug reactions and treatment failures to help determine if they are a candidate for DNA Drug Sensitivity Testing and a Personalized Prescribing evaluation. Based on information compiled from NIH, the FDA, and www.medsandaging.org, you can download the questionnaire at www.HealthandDNA.com/risk.pdf or request copies for yourself or a medical office by calling 800-523-3080 now.

Sources: U.S. Centers for Disease Control and Journal of the American Medical Association

New Plavix Study Confirms Importance of Genetic Testing

Almost all of the deaths and major cardiovascular events observed in Plavix patients occurred in poor metabolizers of a liver enzyme called CYP2C19, according to data from the GIFT sub study of GRAVITAS presented at American College of Cardiology 2011 annual meeting. Poor metabolizers are people who lack the DNA coding required for their bodies to make CYP2C19, which acts on about 10% of medications. Approximately 2-4% of European origin individuals, 10% of Africans, and up to 20% of Asians are CYP2C19 poor metabolizers. Plavix is a prodrug, taken in an inactive form that requires CYP2C19 to activate it. Additionally, the study found that doubling Plavix dose from 75 to 150 mg improved platelet reactivity results in the one-third of patients who are intermediate metabolizers, but had no impact on poor metabolizers of CYP2C19.

“The thing that hit me in the face was that virtually all of the events were in those [poor
metabolizers].”

- Dr. Gibson, Duke University

Dr. C. Michael Gibson and Dr. Ajay Kirtane from Duke University discussed the study, and both commented that the FDA boxed warning about Plavix genetics was premature until seeing this data. Dr. Kirtane stated, “I’m wondering if maybe we should spend more effort trying to find these non responders for the homozygous gene [poor metabolizers].

Watch the Duke cardiologists discuss the study at www.vimeo.com/22008430

Read details of the study at: www.theheart.org/article/1208199.do

Coming Home to Die of Drug Interactions

The wars in Iraq and Afghanistan have returned 40,000 wounded soldiers to the US, the highest number, compared to combat deaths, of any war in history. Another 300,000 or more troops have returned with traumatic brain injury, P.T.S.D. (post traumatic stress disorder), depression, or chronic pain; difficult to treat conditions our troops will likely suffer from for many years. As a result, psychiatric drugs, central nervous system depressants, and narcotic painkillers have been used by military doctors more than in any previous war. But those medications are being increasingly linked to a rising tide of other problems, among them drug dependency, suicide, and fatal accidents—sometimes from the interaction of the drugs themselves. An Army report on suicide released last year noted that medications were involved in one-third of the record 162 suicides by active-duty soldiers in 2009. An additional 101 soldiers died accidentally from the toxic mixing of prescription drugs from 2006 to 2009. DNA testing can help improve this situation because almost all of the drugs contributing to the drug interactions afflicting our troops are affected by DNA status. When prescribers know the DNA status of their patients, they’re in a better position know when drugs or combinations of drugs will work or when they might be unsafe. Adapted from “For Some Troops, Powerful Drug Cocktails Have Deadly Results,” The New York Times, Feb. 12, 2011