Imagine being able to take a simple oral swab and analyze a set of genes that would allow incredibly more accurate prescribing for drugs that affect pain and the brain. A number of new (for profit) companies are offering just that type of information that promises to take a lot of the guesswork out of prescribing antidepressants, pain meds, soporifics (sleep meds), and others. This type of testing is easy now with results available in 3-4 days.
Side effects are drastically reduced by determining the genetics of which drugs need major dosing reductions and which might be metabolized more predictably. Additionally, the medications that might need heavier dosing in order to be effective are identified for each individual. Pain management, eg, is often complicated by an apparent lack of efficacy. However, this can be the result of detoxification genetics (how individuals might uniquely metabolize any given medication) that may cause unusually rapid clearance. These patients might be labeled as “drug seekers” but are actually in need of higher than average dosing for relief.
What a wonderful advancement now available in the local clinic. Or is it? This relatively new (available now for over a year) tool is still considered “experimental” and not covered under the terms of many 3rd party payers. The cost — well over $1500 if paid out of pocket — would be a major investment in helping patients (and willing MDs) customize their care in a big way. But recent rejections by several Minnesota insurers tells me that we might have to wait a while. This past week I received a somewhat pedantic letter from a BCBS medical director who not only admonished me for prescribing zolpidem (aka, Ambien) to a long suffering insomniac who tolerates it well, but also included abstracts of studies from the medical literature re the dangers. So, as his own company rejects claims for definitive gene testing that would predict adverse reactions and guide MDs into more intelligent clinical choices, they are warning us about the dangers of prescribing it. Seems logical.