Talk

Yet again, I’m frustrated by people confusing web access to genetic services with “direct-to-consumer” testing. Today in Science, Katsanis et al. lump DNA Direct’s gold standard services with what journalists at Newsweek are calling “snake oil.”

Contrary to the article published in Science that is being quoted in other news sources, DNA Direct is a healthcare provider just like any bricks-and-mortar genetics center. We provide medical genetic services according to evidence-based guidelines, under the oversight of a Medical Director who is an M.D. geneticist, and with a focus on proper interpretation of test results.

As a clinical provider committed to helping consumers understand genetic test results in context, it is inaccurate to describe our company as “bypassing doctors, who could help consumers interpret and use the findings.” In fact, we routinely work with physician practices to help both the referring physician and their patient access genetic testing and appropriately interpret the results.

You can read DNA Direct’s official reply to Science here, along with more info on our standards and how we meet professional guidelines.

It is my hope that this article by Katsanis et al. will fuel a debate, regardless of misinformation, prejudice or fear-mongering, that will help this industry rapidly mature. Debate can speed action and provide innovative solutions. As an insider commented, “We NEED articles like this—even if the perspective is one we do not share—because the market needs the acceleration and heat of debate.”

For more statistics about genetic testing for drug metabolism, which was the target of this article in Science, see Eye on DNA’s post and the Personalized Medicine Blog’s response.

Update 4/7: The Genetic Genealogist has a good round-up of news coverage and blog posts on this article.  He says, “…my biggest complaint with many of these articles (especially in the popular media) is that they tend to lump together every test that examines DNA. There are different types of genetic testing with different levels of quality control, interpretation, etc. The results, scientific background, and effects of tests offered by large-scale genome scanning companies, clinical entities, direct-to-consumer companies, and pharmacogenetic companies are not the same. When dealing with a readership that does not have a background in genetics (which is probably 99% of the readership), the media should take extra care to note these differences.”

Amy Harmon looks at the issue of privacy, fear of discrimination, and the very real repercussions some people are facing as a result of the tension between important medical information and lack of comprehensive legislation to protect patients’ genetic privacy.

She quotes Francis Collins, director of the National Human Genome Research Institute at the NIH, “It’s pretty clear that the public is afraid of taking advantage of genetic testing. If that continues, the future of medicine that we would all like to see happen stands the chance of being dead on arrival.”

I don’t think it’s as dire as that, but all of us — patients, physicians, industry and thought leaders — need to push for systemic solutions. Genetic testing is redefining the practice of medicine, and our convoluted infrastructure of delivering healthcare needs to adjust to accommodate it.

Harmon’s profiles of people who have chosen to test, not to test, and to test anonymously by paying for testing themselves illustrate how this tension has a fundamental impact on peoples’ health and families’ lives: (more…)

Business Week’s Debate Room has just posted a debate on insurance coverage for genetic testing. Frankly, it’s not much of a debate. The pros for insurance coverage are presented by Dr. Philip Reilly, an accomplished geneticist and thought leader. He summarizes the current state and likely future of genetic testing. The cons are presented by Greg Fish, an IT business analyst, who offers the usual fear-mongering.

Of note, industry publication Health Plan Week (formerly Managed Care Weekly) just ran an article on exactly this: “Insurers Are Considering Change to Coverage for Genetic Testing and Related Patient Counseling Services.” At this point, coverage isn’t a matter of pro or con, it’s really a matter of which tests and for whom. Genetic testing is here, payers see the promise, and they’re trying to find the best strategies for coverage.

Genetic tests available in the market today fall into four categories, [says Drew Fromkin, CEO of Clinical Data, Inc.]: (more…)

Holy stealth mode, Batman! While everyone’s been buzzing about Navigenics and 23andMe — how they will be offering the first genome-wide array tests soon, what will they offer, how will people react to such information — that pioneering Icelanding genetics company, deCODE, just grabbed the spotlight (again).

Today deCODE unveiled deCODEme, the first consumer service for genome-wide testing. And it looks an awful lot like what we’ve been expecting from 23andMe and Navigenics. Here’s a smattering of what people have to say about it:

I think Nicholas Wade’s phrase “sample the whole genome” is misleading, but I’ll pass on this perspective:

The significance of most variation in the human genome is presently unknown. Most of the SNPs studied so far have been identified in the course of searching for the genetic roots of common diseases, such as cancer, diabetes and heart disease. Because the diseases are common, many people possess the underlying SNPs. So any interpretation of a person’s genome is at present heavily skewed toward generating ominous news. …
There are undoubtedly genes that promote longevity and good health but far fewer of these have yet been spotted. And environmental factors, too, can affect whether certain genes are ever activated.

(more…)

With the recent FDA’s activity in personalized medicine, I asked DNA Direct’s director of pharmacogenetics, Dr. Huijun Z. Ring, if she’d give us a guest post.

Huijun writes:

FDA warns breast-feeding moms of genetic risk for using codeine products
Gene test can help to prevent life-threatening side effects in nursing babies

When I was home with my first baby, my training in science and medicine went out the window, and I found myself to be as much of a novice as every other new mother. I wanted to make sure that everything was perfect. Mostly, however, our family went forward by trial and error, learning as we went along how to care for our new member. Gratifyingly, a recent advance in my field of pharmocogenetics will help remove one uncertainty for mothers.

Codeine is a frequently used medication for mothers after child birth and for infants in their first year life. On Aug 17, the FDA issued a Public Health Advisory warning that a rare, but sometimes life-threatening, side effect of codeine in nursing babies could be attributed to a mother’s genetic makeup. (more…)

MSNBC provides compelling statistics about how genetic testing for warfarin (Coumadin) dosage can make a difference:

FDA economists estimate the genetic testing could prevent 85,000 “serious bleeding events” and 17,000 strokes a year, according to a November 2006 study posted to the Web site of the American Enterprise Institute. The savings to the health care system could be $1.1 billion a year, though some people question that. The genetic tests can cost $125 to $500. About 2 million people start taking the drug each year.

Warfarin sends more than 43,000 people to the emergency room each year, the FDA economists said. That total is more than for any other drug except insulin, which diabetics use.

The Washington Post has a suprisingly brief article, pointing out that

Studies have shown that the risk of a serious bleeding episode — into the brain or intestine, for instance — is highest soon after treatment has begun.

Technorati Tags: warfarin, coumadin, genes, genetic test, fda, label, risk, blood thinner, cost

A new review of the deCODE T2 test for diabetes risk is in — from someone who is a blogger and a nurse, and has type 2 diabetes. Kendra James over at Diabetes Notes talks about both the test and her experience testing through my company. So, I was a bit nervous when a friend emailed me the post.

The good news (for me, as content director):

DNA direct sent me a little email hello to let me know my results were ready, and I just clicked the mouse, logged in and yee-ha, there they were. DNA direct explains the test results in depth and provides many resources to better understand them. They even offer a letter that can be printed out and taken to your doctor. How cool.

They also have a whole team of geneticists and specialists that can provide support and guidance for each individual “tester”. There is a plethra of websites and phone numbers that are also offered to all those that choose to complete deCode’s T2 risk marker test.

The debate (which Hsien and others have echoed):

And that brings me to the only real negative in the whole testing process. Because the deCode T2 Risk factor test is a choice and not a necessary, the cost is $500. You really could argue either way. “Isn’t $500 worth knowing your future and how to prevent diabetes?” The other… “Why pay $500 to find out that you might be at risk. Just eat right and exercise, and that’s all you can do!”

Kendra asks: Would you be interested in taking the test? I’m curious too, so go over to Diabetes Notes and weigh in!

The last Ashkenazi Jewish genetic condition left for me to cover, aside from Cystic Fibrosis which has high carrier rates for all people with Caucasian ancestry (1/25), is Niemann-Pick disease. There are five subtypes of Niemann-Pick disease, though only Type A is more frequent in Ashkenazi Jewish populations.

• Niemann-Pick disease Type A is a neurodegenerative disorder that causes babies to experience feeding difficulty, recurrent vomiting, and enlargement of the spleen and liver. Like Tay-Sachs disease, a child’s decline can be rapid and death usually occurs by 3-5 years of age, due to infections such as pneumonia.
• 1 in 80 Ashkenazi Jews are carriers of Niemann-Pick Type A.
• Genetic testing can tell whether you are an unaffected carrier of Fanconi anemia. Testing detects 99% of carriers for Niemann-Pick Type A.
• Niemann-Pick Type A is inherited in an autosomal recessive fashion, which means that in order for a child to be affected, he or she must inherit two copies of the gene change — one from each parent. If your partner is also a carrier, you have a 1 in 4 chance of having a child with Niemann-Pick Type A disease.
• National Niemann-Pick Disease Foundation
• Other Ashkenazi Jewish genetic conditions
• DNA Direct’s FAQs on Ashkenazi Jewish genetic testing
  

Technorati Tags: niemann-pick disease, type a, ashkenazi jewish diseases, carrier screening, genetic testing, dna

A while back, I began a series of short posts on genetic conditions that are most common in people with Ashkenazi Jewish heritage. Now it’s time to pick those back up again. Where were we? Fanconi Anemia.

Fanconi Anemia is a blood disorder characterized by deficiency of red blood cells, white blood cells and platelets. Fanconi Anemia (Type C) causes developmental delay, increased risk of cancer, and congenital birth defects.

• 1 in 89 people of Jewish ancestry are carriers of the gene alteration that causes Fanconi anemia.
• Some children with Fanconi anemia have been successfully treated with bone marrow transplantation, but this treatment is still experimental.
• There are five subtypes of Fanconi anemia. Only Type C occurs with increased frequency among people with Ashkenazi Jewish ancestry. (more…)

More thoughts on the genomic revolution, who’s involved, what we’re facing and where we’re going.

• U.S. population: 300+ M
• Board-certified physicans: 697,000
• In primary care: About 2 out 5
• M.D. geneticists: 1,178
• Ph.D. geneticists: ~800
• Genetic counselors: ~2,000

That’s about 3.5 geneticists per million population. In addition, MD clinical genetics training programs have had declining numbers of trainees, which means fewer geneticists in future years. The typical clinical geneticist works at an academic medical center, spends approximately 50% of her time in direct patient care, and provides approximately 700 total patient visits per year. 700 patients per 1200 MD geneticists = 840,000 patient per year. That’s today’s bottleneck.

Now, let’s look at the nature of the molecular diagnostics market: in 2005 it was a $6 billion market, of which genetic and pharmacogenetic testing was less than 1/3. In 2010, it’s estimated to be $15 billion, over half of which will be genetic and pharmacogenetic. In 2013, it’s estimated to be $32 billion. That’s big growth.

Where is this growth taking place? (more…)

Not surprisingly, the genomic revolution has a lot of medical professionals who aren’t geneticists* concerned about who’s doing what, and how. This is an important discussion that we should all be having, and it’s captured in what I hope will become a larger discussion begun at Grand Rounds, Volume 3, No 33 and Eye on DNA.

The Blog That Ate Manhattan writes:

Eye on DNA interviews the CEO of Genomic Healthcare Strategies, and gives us a glimpse at a possible future. I was fine till I read the list of new stakeholders in this area, and realized just how much of the trend in health care is to take it out of the hands of physicians and put in anywhere else it will make money in a direct-to-consumer market. I wonder where the ethics in this brave new world will come from?

Eye on DNA responds:

What I’d personally like to see is greater collaboration between physicians, genetic counselors, and patients aka consumers to define a personalized approach to preventing and treating disease. It doesn’t have to be one camp against another. And, in fact, if we persist in keeping secrets from our healthcare providers because we’re afraid of their disapproval or if physicians want to deny services to their patients simply because they are not the conduits, we will create an environment in which useful information is lost.

I would add: (more…)

Mucolipidosis IV (ML4) is a neurodegenerative disorder characterized by growth and developmental delays, progressive retinal degeneration, and crossed eyes. It has relatively high carrier rates in the Ashenazi Jewish community.

• Most infants affected with ML4 develop symptoms within their first year of life, and most never speak, walk, or develop beyond the level of a 1–2 year old. Most people with ML4 usually live into adulthood.
• About 1 in 100 to 1 in 127 people of Ashkenazi Jewish descent are ML4 carriers, which means they have one copy of the gene change that causes Mucolipidosis Type IV.
• When two carriers have a child together, there is a 1 in 4 chance the child will have ML4. (See autosomal recessive inheritance)
• Highly accurate carrier testing and prenatal diagnosis is available for ML4, both for families with a previous history of the disease and for all couples with Ashkenazi Jewish ancestry.
• ML4 Resources: National MPS Society, Inc., ML4 Foundation

Technorati Tags: mucolipidosis type IV, ml4, ashkenazi jewish diseases, carrier testing, genetic testing, genes, inheritance patterns, symptoms, treatment, resources

My sympathies go out to Tony Snow and his family for the latest news about his colon cancer recurrence. In 2005, Snow was diagnosed with Stage 3 colon cancer, had his colon removed and underwent six months of chemotherapy. Now a second cancer has been removed, and reports say it has metastasized to his lever.

Cancer news is never good news. Snow’s news, however, is an unfortunate reminder of my “prevent colon cancer, screen screen screen!” message. (I say this to all my friends when they turn 50.)

• Colon cancer is the third cancer killer in the U.S.
• But, it is the most preventable cancer: if caught in the early stage, it’s 90% treatable.
• The way to catch colon cancer early is to screen for it: by the time someone’s showing symptoms, it’s usually progressed

The American Cancer Society and other medical organizations have recommended the following guidelines for general colorectal cancer screening:

All Men and Women Aged 50 or Older—Everyone aged 50 years or older should be tested routinely. At least 75 percent (3 out of 4) of colorectal cancers occur in people with no family or personal history and no known risk factors that would place them at high risk.

People at Increased Risk—People at increased risk may need to begin screening earlier and more often than people at average risk. Family and personal history should be considered when determining their screening schedules. People considered at high risk are:

• People with a personal or family history of colorectal cancer or polyps
• People who have had inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
• People with genetic syndromes (familial adenomatous polyposis or hereditary nonpolyposis colon cancer)

Regular screening can catch colorectal cancer early, when it is most treatable. Regular screening can save lives.

How do you screen? Colonoscopy is the gold standard. Many people don’t relish this thought. There are other methods - including a stool DNA test (yes, that’s the gene connection in this post). My company’s website has a comparison chart for different screening methods.

Read more: previous posts on colon cancer screening, stool dna testing and the like

Update 3/30: Time magazine echoes the “screen, screen, screen” message.

The best way to manage colon cancer, however, is to prevent it from getting too far. … When caught early, [Dr. Raymond DuBois, incoming provost of MD Anderson Cancer Center and a colon cancer specialist] notes, malignant growths still contained in the intestine can be removed with surgery, and 50% of patients are cured this way. About 30% of colon cancer patients, however, are diagnosed with the disease after it has progressed to more advanced stages, and spread to other organs such as the liver. “The one important message for everyone is that you don’t have to go through what Tony Snow is [going through],” says DuBois.

Technorati Tags: tony snow, colon cancer, recurrence, colorectal cancer screening, screening recommendations, american cancer society, screening methods, stool DNA test

Canavan disease is one of the most common Ashkenazi Jewish genetic conditions. 1 in 40 Ashkenazi Jews are carriers of Canavan disease. As a result of this high carrier rate and the seriousness of the condition, the American College of Medical Genetics and the American College of Obstetrics and Gynecology recommend Canavan carrier screening for all Ashkenazi Jewish individuals before pregnancy. (Here’s the ACMG statement)

• Canavan disease characterized by developmental delay, a large size head, seizures, blindness, and gastrointestinal problems.
• Genetic testing is available to determine if a person is a carrier of Canavan disease. Testing can identify about 97% of Ashkenazi Jewish carriers.
• When two carriers have a child together, there is a 1 in 4 chance the child will have Canavan. (See autosomal recessive inheritance)
• 1 in 5,000 Jews have Canavan disease. (With carrier screening, it’s likely that this number is shrinking.)
• Canavan disease is caused by a deficiency of an enzyme, aspartoacylase. This enzyme is necessary for the maintenance of the myelin sheaths of nerve cells. Deficiency in the enzyme causes progressive degeneration of the central nervous system.
• No treatment is currently available for Canavan disease.
• Resources for Canavan disease: The Canavan Foundation, The Canavan Research Foundation, The United Leukodystrophy Foundation
• More posts about Ashkenazi Jewish genetic conditions

Technorati Tags: canavan disease, ashkenazi jewish diseases, carrier testing, genetic testing, genes, inheritance patterns, symptoms, treatment, resources

Familial Dysautonomia, also called FD, is a neurologic disorder characterized by episodic vomiting, abnormal sweating, pain and temperature insensitivity, an inability to produce tears, scoliosis, and abnormal feeding and sucking difficulties. This disease is found almost exclusively in Ashkenazi Jewish families.

• 1 in every 36 Ashkenazi Jews is a carrier of FD – and the disease is almost exclusively found in Ashkenazi Jewish families.
• When two carriers have a child together, there is a 1 in 4 chance the child will have Familial Dysautonomia. (See autosomal recessive inheritance)
• Genetic testing, also called “carrier screening”, is available to determine if you are a carrier of FD. This test has a detection rate of 99%.
• A single mutation on the IKBKAP gene on chromosome 9 accounts for most cases of FD.
• The only treatments available for FD treat the symptoms of the disease. Though the treatments cannot cure FD, they can improve the length and quality of a patient’s life.
• Resources for families with FD: FD Hope, National Dysautonomia Research Foundation, Dysautonomia Treatment and Evaluation Center, Dysautonomia Foundation, Inc.
• Why certain genetic conditions are found almost exclusively in certain ethnic groups: the “founder effect” and “beneficial mutation” theory.
• More posts about Ashkenazi Jewish genetic conditions

Technorati Tags: familial dysautonomia, ashkenazi jewish diseases, carrier testing, genetic testing, genes, inheritance patterns, symptoms, treatment, resources

Last night, our local PBS affiliate aired a segment on “Genetic Testing Through the Web“. (You can view the full segment online here.) Ironically, they spent more time discussing traditional methods of genetic counseling and testing services, as provided by UCSF’s Cancer Risk Program. But, they did a great job explaining what genetic counselors do and why genetic counseling is a critical component of genetic testing. It’s always good to to see GCs getting their props.

As with just about every piece that spotlights genetic testing, they profiled genetic testing for hereditary cancer risk. If it isn’t cancer, then it’s Huntington’s Disease. How come we never hear about carrier screening, and other types of genetic testing that are relevant to a much larger population?

With media coverage, I’m always fascinated to see the story-angle they take and how the final edit plays out. (more…)

Here are fast facts about Gaucher Disease, the most common genetic condition in Ashkenazi Jewish people.

• 1 in every 18 Ashkenazi Jews is a carrier for Gaucher disease.
• Carriers are unaffected, but when two carrier have a child, they have a 1 in 4 (25%) chance of having a child with Gaucher disease.
• Gaucher disease mainly affects the spleen, liver, and bones, and occasionally the lungs, kidneys, and brain. This disease can range in severity from mild to chronic.
• Symptoms of Gaucher disease can develop at any age, but they frequently begin during adolescence and early adulthood.
• The most common symptom is chronic fatigue caused by anemia. People may experience easy bruising, nosebleeds, bleeding gums, and prolonged and heavy bleeding with menstruation and after childbirth. (more…)

The Washington Post has an unusually lengthly article on DNA testing to determine warfarin dosing. Recently, I blogged about the launch of this testing: “Warfarin Sensitivity Test Launches.”

Warfarin (brand name Coumadin) is a popular blood-thinning medication used by about 2 million Americans. It’s prescribed after surgeries, strokes, blood clots, and to prevent blood clots. Medco Health Solutions and the Mayo Clinic are collaborating on a project using this testing to determine initial dosing for patients.

Epstein and other experts say the warfarin projects comprise the first broad use of personalized medicine, or targeted therapy, in which a person’s genetic makeup is used to pick the best medicine or dose. This approach essentially adjusts for differences in body chemistry that explain why one pain reliever or allergy pill works great for you but not for your mom. … (more…)

Happy new year, everyone! I just returned from an unusually exciting break (more on that in later posts) to find that genetic testing is the cover story of this week’s US News & World Reports:

Unraveling Your DNA’s Secrets: Do-it-yourself genetic tests promise to reveal your risk of coming down with a disease. But do they really deliver?

Also, you can now listen to public radio’s December 21 Health Dialogues’ program online:

Genes, Disease and Difference

The program begins with the story of a woman who pursued genetic testing for tamoxifen efficacy, but the panel discussion is wide-ranging, with perspectives from all over the industry.

Technorati Tags: news, dna, genetic testing, disease risk, tamoxifen, media coverage

If you’re 50 years old or older, you’ve been told “Time to get a colonoscopy.” But have you done it? Not exactly the birthday present you’d like, eh?

Everyone should do it, no one wants to, and until now we’ve thought it’s the best way to prevent colon cancer — which is the third most common cancer in the U.S. and the most preventable.

Colonoscopy is the “gold standard” for screening - meaning all the docs say it’s the very best way to detect colon cancer and pre-cancerous polyps. But today’s NY Times has an illuminating article about this:

[A] new study, published today in The New England Journal of Medicine, provides a graphic illustration of how wrong that assumption can be, gastroenterologists say. The study, of 12 highly experienced board-certified gastroenterologists in private practice, found some were 10 times better than others at finding adenomas, the polyps that can turn into cancer. One factor distinguishing the physicians who found many adenomas from those who found few was the amount of time spent examining the colon….

(more…)

“Will insurance cover my genetic test?” is one of the most popular - perhaps the most popular - question we get at DNA Direct. For some genetic tests, the answer is pretty straightforward (”probably, here’s why…”). For other genetic tests, it’s more complicated.

Recently the magazine, Managed Care, ran a detailed article about exactly this issue. It begins with scenarios in which insurance company medical directors granted and denied coverage for genetic tests, and why:

• “It can’t be a fishing expedition.” Coverage denied for a handful of genetic tests.
• “This is the role genetic testing should play — when all else has been eliminated.” Coverage granted for Fragile X testing.

Of more interest to me is the detailed exploration, from the position of the insurance companies, how their policies and coverage is evolving in the face of cheaper genetic testing, patient fears of genetic discrimination, and the advent of personalized medicine.

Here’s one perspective, from an insurance company: (more…)

Are you generally curious about genetic testing? I highly recommend reading “Peering Into the Future“, which ran in the latest issue of Newsweek.

Genetic testing is transforming medicine—and the way families think about their health. As science unlocks the intricate secrets of DNA, we face difficult choices and new challenges.

You name it, this article covers it: the $1000 genome, pre-implantation genetic diagnosis to prevent passing on serious genetic diseases to children, Huntington’s disease, the development of early-onset Alzheimer’s gene testing (could be as early as 5 years down the road, says the expert quoted), buyer beware warnings about internet companies that sell dubious genetic tests and product “solutions” such as vitamins — and more. The families interviewed put a very personal lens on issues that too often fall prey to high-minded discussion.

Personally, it makes me happy to see a thoughtful, even-handed discussion about the current (and near-future) state of genetic testing that isn’t sensationalistic, scare-mongering, or science fiction.

Technorati Tags: genetic testing, 00 genome, pgd, huntington’s disease, alzheimer’s disease, nutrigenomics

Since DNA Direct first began offering CYP2D6 testing for tamoxifen efficacy last month, we’ve had calls from women asking, “how come my doctor didn’t recommend this?” and “why doesn’t my doctor know about this?”

Dr. Kevin Knopf, a respected medical oncologist who specializes in breast cancer, has an explanation in his post this week “Something to Worry About? Tamoxifen Effectiveness.” He wrote this post upon first learning about tamoxifen and 2D6 — from his newspaper. He says:

It is also interesting how oncologists and other doctors find out about news this big – were it not for my newspaper I don’t know when it would first come to my attention (I’ll let you know next month!) When I asked my partner if he had heard about it, it was news to him. There are often no “mass broadcasts” of “breaking news” –e.g. nothing on my email yet. So this can create anxiety for patients who might see something before their oncologist does. I think the best approach would be to let the information get absorbed prior to making any decisions about tamoxifen and to seek guidance from your personal oncologist.

(more…)

The only recent coverage I’ve seen so far about the FDA’s relabeling of tamoxifen on is from the PGx Reporter, which is subscription-only. Here’s their public excerpt:

FDA Panel Leans Toward Including CYP2D6
Dx in Tamoxifen Label, But is Split on Language

The Pharmaceutical Science Clinical Pharmacology Subcommittee was split over whether the label should “recommend” the genetic test or make it an “option” for health care providers and patients to discuss.

As it considers just how strong the wording on the label should be, the FDA is looking at the role of endoxifen (the active metabolite), 2D6, and drug interactions.

We’re getting many inquiries ourselves into the Tamoxifen 2D6 Test. Here are recently asked questions and answers, and previous posts on Tamoxifen and 2D6 Testing.

Technorati Tags: tamoxifen, cyp2d6, genes, drug metabolism, fda recommendation, drug interactions, genetic test, dna

Have you had a blood clot or DVT? If so, chances are you’ve been on warfarin (brand name: Coumadin). Warfarin, a blood-thinner, is the most commonly prescribed drug for preventing and treating blood clots.

Warfarin is also known to be a difficult drug to manage, for two reasons. First, the blood levels in which warfarin is effective are very narrow, which means doctors need to carefully calibrate the dose. Secondly, people have a wide range of responses to it, which means calibrating the dose is more challenging.

Kimball Genetics (a laboratory) has just launched a genetic test for warfarin sensitivity, which better predicts an individual’s response to warfarin. This test can help your doctor determine the warfarin dosage that’s best for you — lowered risks, maximum effectiveness. (more…)