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PERSONALIZED
MEDICINE
By Stephanie Patrick
It’s well known that genetics can influence a patient’s response to
medications, and the combination even proves toxic at times. But
thanks to research and the growing popularity of pharmacogenomic
testing, the medical community knows more about the relationship
between genes and drug responses than ever before.
Pharmacogenomic testing increases patients’ treatment compliance,
and studies show it improves outcomes in such areas as psychiatry,
cardiology and pain management. However, little is known about
health care providers’ perceptions and concerns about the tests.
So J. Dru Riddle, assistant professor of professional practice at Harris
College of Nursing & Health Sciences’ School of Nurse Anesthesia,
spent the past year interviewing 17 North Texas nurse anesthetists and
one anesthesiologist in an attempt to learn more.
“For the patient, we are always trying to find the right drug at the right
dose at the right time,” said Riddle. “Pharmacogenomics is embarking
into the era of personalized medicine — really being able to administer
anesthesia based on what the individual’s genetic profile tells us the
response will be.”
However, Riddle’s research, which was conducted via face-to-face
interviews, found that no one surveyed had used pharmacogenomic
testing yet, primarily due to a lack of understanding about how to
use the data and even how to order the tests. He stressed that his
study, at least at this early stage, will not determine what should
be done and when tests should be ordered. Its purpose is simply
to discover what anesthesia providers are thinking and feeling
about pharmacogenomics.
“My focus is mainly on pain medication,” said Riddle, who chose to
interview active health care providers working in smaller or midsize
research centers with limited access to the latest technologies. “In
anesthesia, of course, one of our big goals is to prevent or reduce
the amount of pain patients experience. But quite honestly, the way
medications are picked is sort of a trial-and-error decision based on
patient history or because the provider likes a particular drug over the
other ones.”
He found economics to be a major concern. Pharmacogenomic
tests have to go to specialized labs, and costs vary greatly; providers
expressed concern over whether the costs justify the perceived benefits.
Riddle believes they do.
“Pain medicine can be very dangerous,” said Riddle, who expects
to finish his Ph.D. in December and is using this study as part of a
doctoral dissertation. “If you give a patient pain medication in small
doses and they happen to be sensitive to that medicine, it can cause
things ranging from sedation, itching and other irritating side effects to
respiratory depression or even respiratory arrest.”
Knowing that 18 respondents recruited through colleagues and
word-of-mouth can introduce bias into a study, Riddle will soon
electronically survey as many as 5,000 nurse anesthetists using a list
from the American Association of Nurse Anesthetists. He is working on
the survey questions now and plans to distribute the survey in August
or September.
TCU’s School of Anesthesia provided an initial $3,000 for the study,
and Riddle hopes to receive $4,000 more in the future. He is also
seeking a larger grant that will help develop an intervention or tool to
increase pharmacogenomics knowledge and understanding among
anesthesia providers. This could even take the form of an interactive
learning module or an app.
“It’s a matter of training health care providers to understand what
the technology does, what the test results mean and how to use
it in practice,” he said. “That’s what I hope to do, ultimately, with
this research.”
Pharmacogenomic testing is the future of anesthesia care, agrees Kay
Keller Sanders, professor of professional practice and director of the
School of Nurse Anesthesia.
“If you can imagine it, it will happen in medicine,” she said.
Riddle says testing every patient probably won’t be a reality until
costs decrease significantly. But testing patients who’ve reported bad
experiences with specific medications could become commonplace in
just a few years.
“If I had a crystal ball, I would hope my little bit of research will help
contribute to the bigger body of knowledge about how we as health
care providers understand genetics and genomics — specifically, how
we can make better decisions about the medications we give our
patients,”he said. “We know enough now to make the practice of health
care safer.”
FEATURES
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· Harris College of Nursing & Health Sciences