Genetic testing could save millions and improve care

By WYATT EMMERICH,

Mississippi Spends about $350 million dollars a year on prescription drugs through its Medicaid program.

Unfortunately, a huge percentage of that money is wasted because the drugs don’t work. A mouth swab genetic test could fix that, but progress is slow in our state.

Expensive drugs such as statins, diabetes medications, blood thinners, antidepressives and the like are covered under Mississippi Medicaid but the genetic tests that can determine whether they work aren’t covered.

More progressive states such as Texas and Georgia have figured this out. As a result, the right medications are getting prescribed to the right people. Mississippi should do the same. It could save a hundred million dollars a year and vastly increase the health of hundreds of thousands of patients.

We all know about genetic testing. It’s producing new miracles every year. Now a genetic test done by swabbing the cheek of your mouth can determine what medications will work for you and which ones won’t.

The results are staggering. As it turns out, about a third of the prescriptions are ineffective because of genetic variances among individuals. Worse, they cause bad side effects.

A recent Mayo Clinic study regarding depression found a 70 percent improvement in results when genetic testing was done to determine what drugs would work best with what patient.

It has to do with enzymes in the liver. About half of all drugs must be synthesized by enzymes in the liver to work. If you don’t have the right enzyme, the drug will not only not work, it will cause bad side effects.

About a third of the people lack the right level of enzymes for many of the best selling drugs to work, so a third of the money spent on prescription drugs is wasted. A genetic test, costing anywhere from $1,200 to $1,800 can fix that by identifying which patients have which enzymes. No doubt the cost will come down as time goes on.

I have personal experience with this. My son was given medications relating to autism. His condition dramatically worsened, precipitating a crisis.

I was blessed to have a close friend, Bob Crisler, who has a company in the genetic testing business. He walked me through the process and got me to insist that the psychiatrist do the genetic testing. As it turned out, my son lacked enough enzymes to metabolize the drug. Not only was the drug not helping, it was hurting. With the test results in hand, I insisted his medication be changed. The difference was staggering. Within a few days, he recovered and has been fine ever since. “You saved his life,” I often tell Bob.

Here’s another example: I use an old-style antihistamine, chlorpheniramine when I can’t sleep. It’s old, cheap and over-the-counter. When my wife Ginny was having insomnia, I suggested she try it. It made her bounce off the walls.

As it turns out, chlorpheniramine requires a genetically coded liver enzyme to work. I have it. My wife doesn’t. So we had dramatically different results.

The same is true with statins, diabetes drugs, blood thinners, ADHD meds, blood pressure meds, mood stabilizers and many other commonplace drugs. Hundreds of thousands of Mississippians are taking the wrong drugs wasting millions and furthering disease. What a shame.

During my experience with my son, I stood facing a psychiatrist with my son’s genetic test results in my hand. “Mr. Emmerich, you seem to think I don’t believe in genetic testing. I do. It is established technology,” the psychiatrist assured me.

I wanted to ask him, “Then why did you not use it in the first place instead of allowing my child to suffer when a simple genetic test could have avoided that.” Instead, I shyly thanked him and walked away.

 

My heart goes out to all the people who are suffering from the wrong medication. As a practical matter, Mississippi could save millions in Medicaid expenses if they took an aggressive stance toward genetic testing. Less trial and error. Fewer hospital visits. Better health.

I just recently covered a class action trial regarding the East Mississippi Correctional Facility (EMCR). Ninety percent of the prisoners there suffer from mental illness, causing bedlam. The prison is a disaster.

Imagine, if all those prisoners were genetically tested and given medications that actually worked based on their enzyme makeup. Many lives would be saved, not to mention a huge reduction in prison costs.

Bob’s company, Medical Spark, has struggled to break through the monolithic state bureaucracy that runs at a snail’s pace. It’s tough slogging attempting to get a conservative state to adopt cutting edge technology.

Even so, his company recently tested a sample of 137 patients at two Veterans Administration nursing homes. The results show a third of the vets lack enzymes that would allow common medications to work properly.

The testing was done by GeneTrait, a Columbia, Missouri, company that is owned by its founders. Their expertise is taking complex genetic information and reducing it to easy-to-understand guidelines to assist physicians in prescribing the right meds.

Let’s take Plavix, a common anticoagulant, for example. GeneTrait’s testing found that only a third of the nursing home patients had the enzyme variant, CY2PC19, to process Plavix correctly. Two-thirds had either an under-response or over-response, which can lead to either heart attack or stroke. Similar results were found with a wide variety of common drugs for common illnesses.

A third of the patients lacked the enzyme to metabolize Celebrex, a common pain reliever. Half the patients lacked the enzyme to process respiridone, a common prescription for bipolar disorder. And so on.

In essence, genetic testing can vastly improve medical results by getting the right medications to the right people. This will improve results and save money. But change is slow. There is resistance in the medical community. People fear change. Technology can be threatening.

But change will come. It’s hard to stop progress. A good first step would be for the Mississippi Department of Medicaid to embrace genetic testing and designate it a covered procedure.

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