Beta

Slashdot: News for Nerds

×

Welcome to the Slashdot Beta site -- learn more here. Use the link in the footer or click here to return to the Classic version of Slashdot.

Thank you!

Before you choose to head back to the Classic look of the site, we'd appreciate it if you share your thoughts on the Beta; your feedback is what drives our ongoing development.

Beta is different and we value you taking the time to try it out. Please take a look at the changes we've made in Beta and  learn more about it. Thanks for reading, and for making the site better!

The Best Medications For Your Genes

kdawson posted more than 4 years ago | from the bespoke-drugs dept.

Biotech 75

blackbearnh writes "Until recently, physicians prescribed drugs to patients with dosages based only on weight, and with no idea if the drug would be effective for that particular person. But as this article on Forbes.com highlights, the same advances in genomics that are letting people know about their likelihood of getting certain diseases can also let doctors know what drugs, and what dosages, will be likely to do the most good. 'Tamoxifen, the much-heralded cancer-fighting drug, has been shown to have little benefit for 7% to 10% of patients taking it. In the past, we would have just said that it works 90% of the time. But now, with our new genomic knowledge under our belt, we can say that it works nearly 100% of the time for people with the 'right' version of the CYP2D6 gene, and 0% of the time for people with the 'wrong' version, who make up roughly 7% to 10% of the population.'"

cancel ×

75 comments

next up.. (5, Insightful)

blool (798681) | more than 4 years ago | (#29894181)

getting denied health insurance for having bad genes

Re:next up.. (2, Interesting)

cjfs (1253208) | more than 4 years ago | (#29894211)

It's not hard to imagine a future in which patients entering an emergency room will have a CD disc with their entire genome tucked in their wallets or on file with a national database. Before any drugs are administered, dosages will be adjusted based on the patient's genomic profile.

And that same genomic profile will determine if they can get coverage in the first place. Think of the cost reductions this new streamlined process will bring!

I mean, we just need this national database to better serve you.

Re:next up.. (4, Informative)

Jayemji (1054886) | more than 4 years ago | (#29894261)

Except that'd be a Violation of http://en.wikipedia.org/wiki/Genetic_Information_Nondiscrimination_Act>

Re:next up.. (5, Insightful)

cjfs (1253208) | more than 4 years ago | (#29894301)

And are you confident, given the current level of lobbying, that the U.S. government won't pass the "Comprehensive, Affordable, Reliable, Effective Health Act"? I mean who would vote against the C.A.R.E health act that's "designed to lower health premiums for hard working American families"?

You might be surprised how much more power the industry will gain if public options fail.

Re:next up.. (3, Insightful)

smchris (464899) | more than 4 years ago | (#29895251)

No, I'm not that confident, but I'm taking a chance on the 23andme.com database security anyway. Just signed up and the contract does give one pause. They point out that loose talk with your doctor can be dangerous. I don't know how far law will protect a person against medical and employment discrimination in practice but they mention that the law does not protect your ability to get _life_ insurance.

On topic, they routinely test for warfarin sensitivity and Plavix efficacy.

Re:next up.. (0)

Anonymous Coward | more than 4 years ago | (#29895949)

How is this a +5 Insightful and the GP post -1 Flamebait? You can't have it both ways!

Re:next up.. (0)

Anonymous Coward | more than 4 years ago | (#29896745)

So the logical thing to do then is give the industry to the federal government? Do you really trust the government with your life? And if you do, can you guarantee that you can trust the future governments with the power being given to them?

Re:next up.. (1)

left00coaster (933396) | more than 4 years ago | (#29910137)

No. The logical thing to do is set up a government-subsidized public option . . . or do you trust insurance companies with your life?

Re:next up.. (1)

sorak (246725) | more than 4 years ago | (#29899653)

Thank FSM! I was wondering if susceptibility to heart disease, cancer, etc, could render those diseases to be pre-existing conditions.

Public healthcare (2, Insightful)

googlesmith123 (1546733) | more than 4 years ago | (#29894305)

That's why many countries have public health care. It's just simply fairer and better.

Re:Public healthcare (1, Insightful)

Anonymous Coward | more than 4 years ago | (#29894373)

Hey man, there needs to be competition to foster new innovations in a...fairly static and sedentary industry.

I mean come on, competition exists in health care since one provides service A and the other provides...the exact same service.

Alright, someone tell me exactly how insurance companies compete with each other to foster new innovations. Hell, internet providers have at least newly developing tech for new, faster internets (although not so much in the US of A) but what can insurance companies do? Patent drugs or new procedures so only insurance provider A can provide it?

Re:Public healthcare (3, Informative)

Jayemji (1054886) | more than 4 years ago | (#29894469)

Well since Medical Insurers are exempt from anti-trust law, they have to DON'T compete AT ALL. Period. They can get away, legally, with things that would put the worst anti-trust abusers to shame. http://en.wikipedia.org/wiki/McCarran%E2%80%93Ferguson_Act [wikipedia.org]

Re:Public healthcare (3, Insightful)

noundi (1044080) | more than 4 years ago | (#29894561)

Hey man, there needs to be competition to foster new innovations in a...fairly static and sedentary industry.

I mean come on, competition exists in health care since one provides service A and the other provides...the exact same service.

Alright, someone tell me exactly how insurance companies compete with each other to foster new innovations. Hell, internet providers have at least newly developing tech for new, faster internets (although not so much in the US of A) but what can insurance companies do? Patent drugs or new procedures so only insurance provider A can provide it?

Are you joking or just really fucking dumb? The comptetition does exist -- but in medicine -- where there are innovations. In hospitals however there are protocols and rules. Doctors don't "invent" anything. Denying people healthcare because they cannot afford it does not foster new innovations -- it fosters death and diseases. Diseases which later on are mutated and spread on to you, simply because the people around you couldn't afford the bill. You have to be one dumb motherfucker to not get this -- really.
 
In other news, say what you want about republicans or democrats, but to fight against a public healthcare system without realising how self destructive that is takes one ignorant fucker. Unfortunately in a democratic system that ignorant fucker could eventually be responsible for the state of my health -- no matter how rich or poor I am.

Re:Public healthcare (-1, Offtopic)

Anonymous Coward | more than 4 years ago | (#29895585)

how the hell did this get +3 insightful instead of the biggest WHOOSH of all time.

Re:Public healthcare (1)

psm321 (450181) | more than 4 years ago | (#29895901)

Umm, did you read the post you were replying to? He's on your (and incidentally, my) side.

Re:Public healthcare (1)

noundi (1044080) | more than 4 years ago | (#29896439)

Umm, did you read the post you were replying to? He's on your (and incidentally, my) side.

In all fairness I did ask if he was joking. I'm a bit feisty today, I admit. But since we all agree let's gather and sing kumbaya. ;-)

Re:Public healthcare (1)

mcgrew (92797) | more than 4 years ago | (#29896459)

You have to be one dumb motherfucker to not get this -- really.

Well, he has to be dumb not to get it, but he doesn't have to fuck anybody's mother. Hell, he's probably a twelve year old virgin.

Re:Public healthcare (1)

mcgrew (92797) | more than 4 years ago | (#29896503)

Somebody please mod the parent up! Except that it's not "many" countries that have public health care, it's MOST countries. We're the only industrialized nation in the world without it, which is why our health care costs way more per capita than any other country's, and we don't have the best care by any metric at all.

So the only place this will be a problem is in the US.

Re:Public healthcare (1)

googlesmith123 (1546733) | more than 4 years ago | (#29927521)

Germany has private health care. Dental care is not covered in Norway.

Just some examples. I'm not an expert so I can't think of any more.

Re:next up.. (2, Insightful)

evilNomad (807119) | more than 4 years ago | (#29894519)

What is this insurance you speak of? In my socialist hell hole we cannot be denied coverage, meaning things like this makes healthcare better, more effective, potentially cheaper (rarely do things get cheaper in this socialist paradise though..) and probably saves lives..

Re:next up.. (1)

that IT girl (864406) | more than 4 years ago | (#29895733)

And mandatory testing and documenting of people's DNA... For your own protection, of course...

Re:next up.. (2, Interesting)

Nadaka (224565) | more than 4 years ago | (#29896749)

Actually, its already here.

The "The Newborn Screening Saves Lives Act of 2007" signed by Bush allows the government to collect, store, test and experiment on the genetic material of every newborn in America without the knowledge or consent of the parents.

Re:next up.. (1)

Grond (15515) | more than 4 years ago | (#29897091)

getting denied health insurance for having bad genes

The federal Genetic Information Nondiscrimination Act [wikipedia.org] is designed to prevent this. There are also supplementary state laws in, for example, Oregon and New Jersey.

Re:next up.. (1)

Ihlosi (895663) | more than 4 years ago | (#29897367)

The federal Genetic Information Nondiscrimination Act is designed to prevent this. There are also supplementary state laws in, for example, Oregon and New Jersey.

I'm quite sure that if the insurers find something wrong with your genes, they can come up with a creative non-gene-related reason for not offering you insurance. Have fun proving that you were discriminated against because of your genes.

Re:next up.. (1)

kalirion (728907) | more than 4 years ago | (#29897459)

So I should be denied the medicine that cures me because you're worried about your health insurance?

Re:next up.. (1)

mea37 (1201159) | more than 4 years ago | (#29897943)

How did I know, as soon as I read TFS, that this sentiment would lead the discussion? For a community that claims to be "nerd"-centric, we have the highest concentration of luddites I've ever seen.

Yes, the nature of risk-pooling groups is that those who are positioned to skim from the pool have an incentive to keep 'high cost' or 'high risk' members out. They always have. They always will. And contrary to a few other posters' responses, public healthcare doesn't fix it - it merely ensures that the entity with the incentive to screw you is your government.

To keep any risk-pooling organization, private or public, from abusing increasing medical knowledge, there are two approaches. One of those (consumer pressure) will never happen, so that leaves regulation. I don't believe for a moment that a public system will be any easier to regulate in this regard; the private vs. public debate is pretty much orthogonal to this issue.

But the bottom line is, this technology will make health care more effective and less expensive. We're talking about less time, money, and lives wasted on attempted treatments that will not work. We're also talking about a new source of information for those trying to develop treatments - "hey, to fill that 7% - 10% gap, we need a treatment that works for this group".

The win-win is where there are two or more treatments, all reasonably affordable, each of which works for a different subset of people but we haven't previously known which will work for a given patient.

Will there be cases where one group is predicted to need more expensive treatment? Yes, at least in the short term. So regulate the ways in which insurance companies manage risk. Will lobbiests try to stop you? Yes, that's an imperfection in the system. The real question is, will you let them get by with it?

indications (2, Insightful)

cstacy (534252) | more than 4 years ago | (#29894191)

Bidil prescriptions should have been based on genetic markers. On the other hand, it's hard to do a credible whole-genome analysis for this sort of thing without a good theory in the first place.

placebo (2, Interesting)

TheLink (130905) | more than 4 years ago | (#29894203)

How about placebos? I suspect they might work much better on some people than others.

Re:placebo (4, Funny)

cjfs (1253208) | more than 4 years ago | (#29894263)

How about placebos? I suspect they might work much better on some people than others.

Very true. I have friends that think they're worthless. But I only have to take 4 of them (1 in each corner of the room, at 9:04am, without exhaling) and my OCD stays completely under control. They make a world of difference.

Re:placebo (1)

Alsee (515537) | more than 4 years ago | (#29900535)

Do you drop a cockroach down your underwear before taking the pills?
I hear they stop working if you don't drop a cockroach down your underwear first.

-

Re:placebo (1)

Artifakt (700173) | more than 4 years ago | (#29895517)

There's some weird evidence that placebos don't do what 'everyone' thinks they do.* It's not conclusive, but maybe we literally don't have a method to test your suspicion.

* Short form, opiate blocking drugs also block placebos if these are given as pain relievers, and maybe don't block them if they are given for other reasons.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T0K-3W0NBP2-1C&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1067752221&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=da2d59bff82ca9795853596a37df11bb [sciencedirect.com]

So, maybe placebos don't work better on some people than others. Worse, maybe what you've said looks like one of those obvious things where some silly researchers deserve an ignoble prize for doing trivial research to confirm what everybody knows, only they came up with a real puzzler instead. Based on the research, it could be impossible to design an experiment that really disproves the claim "placebos have psychological effects", yet it could be untrue. It's becoming a sort of Godel's paradox in pharmacology.
      I'm sure you didn't intend to be serious, but I'm glad you got modded interesting instead of funny.

Re:placebo (1)

TheLink (130905) | more than 4 years ago | (#29898023)

Unless I misunderstand the link, for the people who experience the placebo effect for pain relief, naloxone blocks the effect, and proglumide increases the effectiveness. But for the people who don't experience the placebo effect neither of them do anything.

If that's the case I don't see how that prevents anyone from testing my suspicion.

But it may well that a person that's susceptible to placebo pain relief might not be susceptible to placebo treatment for something else. However that would also be worth investigating.

I hear in some burn cases they can't use real pain killers, so they inject saline into them and tell them it's a powerful painkiller. And it works well for enough people. Another thing expensive placebos work better than cheap ones:

http://psychologyofpain.blogspot.com/2008/10/ig-nobel-prize-for-study-on-placebo.html [blogspot.com]

[matrix]Your mind makes it real[/matrix] :)

version controll (3, Funny)

sdiz (224607) | more than 4 years ago | (#29894265)

... "right" version of the CYP2D6 gene

They should have used git for version control.

Re:version controll (1)

AniVisual (1373773) | more than 4 years ago | (#29920957)

Actually, they store 'em in databases. A fixed summary would read:

... "right" allele of the CYP2D6 gene

Upgrade your firmware (-1, Redundant)

Anonymous Coward | more than 4 years ago | (#29894287)

we can say that it works nearly 100% of the time for people with the "right" version of the CYP2D6 gene, and 0% of the time for people with the "wrong" version

You can grab the latest version from the svn repository.

Re:Upgrade your firmware (1)

Matrix14 (135171) | more than 4 years ago | (#29895403)

That may be the most inexplicable use of mod points I have ever seen.

(The parent is currently modded -1, redundant.)

Tailoring Medicine to Genes: What took so long? (1, Insightful)

reporter (666905) | more than 4 years ago | (#29894295)

Too often, religion interferes with science. Here, "religion" is not merely the traditional ones: Christianity, Buddhism, etc.

Religion is any collection of assertions that are prohibited from being questioned or verified. We simply assume them to be true.

In the case of medicine, one type of religion is the assertion that both men and women exhibit no differences in responding to treatment by the same drugs. About 15 years ago, the medical community admitted that this assertion is false [womenshealthresearch.org] . Congress began deliberately funding the development of drugs that specifically help women.

The grip of religion on medicine has still not been broken. Nowadays, the politically correct religion is the assertion that all ethnic groups and all racial groups are genetically identical. Therefore, researchers should not study ethnic or racial differences in the efficacy of various drugs.

When will we admit that there are genetic differences? For example, most East Asians suffer from lactose intolerance. Europeans do not.

The current attempt to use a person's genes to determine the efficacy of anti-cancer drugs is a first step in breaking this politically correct religion.

Re:Tailoring Medicine to Genes: What took so long? (0)

TheLink (130905) | more than 4 years ago | (#29894403)

> When will we admit that there are genetic differences? For example, most East Asians suffer from lactose intolerance. Europeans do not.

Despite more than 1 billion Chinese people out there, so far none have done very well in the 100m sprinting event. Don't see any Usain Bolts coming from those lines any time soon... There are just a few million Jews, but they have contributed disproportionately in so many fields - science and arts. And great influence in other fields such as finance.

I believe there are breeds of humans just like there are breeds of dogs. The differences aren't as marked/significant as they are for dogs, but they are certainly there.

Re:Tailoring Medicine to Genes: What took so long? (5, Insightful)

thefirelane (586885) | more than 4 years ago | (#29894713)

The problem is, you are, like soooo many before you, confusing significant cultural influence with some sort of inborn genetic trait: >so far none have done very well in the 100m sprinting event So you are saying that there is some "karate gene" then? What gene makes Americans poor at soccer while great at Basketball? The point is, certain cultures value certain sports more than others, and thus those sports attract the pool of athletes from a certain country. >And great influence in other fields such as finance. You realize that Jews were basically *forced* to be bankers for a large part of history right? Tax and interest collection as seen as Taboo for Christians, so they made the jews do it. Same thing with science: if you can get run out of town at a moments notice, you tend to value learning and intelligence, as those are things that pack easily.

Re:Tailoring Medicine to Genes: What took so long? (1)

TheLink (130905) | more than 4 years ago | (#29895115)

Genes do have a strong influence over intelligence. Just a few genetic differences can make a world of a difference. Chimpanzees are supposedly very similar to humans genetically, but they certainly have very different IQs.

There may indeed be karate genes, after all I doubt a hamster is going to win any world karate championships. But the karate related genes are many and have multiple purposes.

Seriously though, winning a 100m race just involves you running faster than the rest - far simpler process (not saying it's _easy_, just less complex). Winning a karate championship on the other hand requires you to actively adapt to and anticipate other people's actions which can change in response and anticipation to yours. So it is likely to involve a lot more genes.

You could be born blind (faulty genes for that) and still win a world class 100 metre race, but if you're blind you'd have to be amazingly good in other areas to still beat sighted world-class opponents.

So the Jews that didn't value learning and intelligence died out? And so now more of them are smarter? Sounds like selective breeding to me. No doubt nurture plays a significant role in development, but they're more of "watering and feeding the plant". Given a reasonable environment, the plant you eventually get depends a lot on its genes.

Re:Tailoring Medicine to Genes: What took so long? (1)

Mathinker (909784) | more than 4 years ago | (#29894853)

> And great influence in other fields such as finance.

Er, you should have stopped while you were ahead?

> I believe there are breeds of humans just like there are breeds of dogs.

You really should have stopped while you were ahead!

Re:Tailoring Medicine to Genes: What took so long? (1)

TheLink (130905) | more than 4 years ago | (#29895365)

> > I believe there are breeds of humans just like there are breeds of dogs.
> You really should have stopped while you were ahead!

Sorry, I'm still ahead and not stopping for you. Try harder to keep up next time. I hope that's not the best you can do.

Re:Tailoring Medicine to Genes: What took so long? (2, Informative)

Ihlosi (895663) | more than 4 years ago | (#29894685)

When will we admit that there are genetic differences? For example, most East Asians suffer from lactose intolerance. Europeans do not.

You got that the wrong way . It should be: Most Europeans are mutant freaks that tolerate lactose as adults, while most East Asians still have the normal version of the genes that prevent the consumption of milk by adults (like most other mammals do).

That adult mammals do not tolerate lactose is the norm. Hence the lactose tolerance of Europeans is the exception.

Re:Tailoring Medicine to Genes: What took so long? (0, Flamebait)

mcgrew (92797) | more than 4 years ago | (#29897687)

If evolution produces "mutant freaks" than every member of every species is a mutant freak. Lactose tolerance evolved because of a lack of food. Those able to drink milk further into their lives had a better chance of not starving to death before they procreated.

That adult mammals (including the other ape species) are covered in thick fur is also the norm, does that mean all humans are mutant freaks?

Re:Tailoring Medicine to Genes: What took so long? (2, Interesting)

Anonymous Coward | more than 4 years ago | (#29894695)

My pharmacogenetics Prof. (yes, its not that new a field)explained it like this:

They had conducted a study which hinted that a whopping 40% of a population showed a genetic variety which renders a particular pharmaceutic more effective at treating a condition than any other. ...so they contacted the manufacturer and asked them if they were interested in conducting a prospective study.
well, they weren't. and why? because 40% of the population is not good enough, they want their product to be prescribed to every single patient, regardless of the facts.

Re:Tailoring Medicine to Genes: What took so long? (1)

vadim_t (324782) | more than 4 years ago | (#29895157)

Nowadays, the politically correct religion is the assertion that all ethnic groups and all racial groups are genetically identical. Therefore, researchers should not study ethnic or racial differences in the efficacy of various drugs.

Does it make sense to put much weight on this though?

Nowadays, somebody from Australia can travel to the other side of the planet and have children with somebody born there. Formerly some areas were very separate and would tend to have some consistency in the genetics, but these days with the easy availability of travel from anywhere to anywhere on the planet, genes are going to get mixed quite a lot.

IMO it doesn't make sense to classify people by race. If something like lactose intolerance matters for some purpose, then we should simply test the person for it, instead of making an assumption.

Re:Tailoring Medicine to Genes: What took so long? (1)

mcgrew (92797) | more than 4 years ago | (#29897621)

Nowadays, the politically correct religion is the assertion that all ethnic groups and all racial groups are genetically identical.

I see you haven't read a newspaper in a while. Or even Googled [google.com] your absurd claims. Hell, you didn't even give it any thought; if it's true that it's taboo to study racial differences, than how do you know that Asians are lactose intolerant while Europeans are not?

Whoever modded you "insightful" needs to get another cup of coffee before doing any more moderations.

What about privacy concerns? (2, Insightful)

torrija (993870) | more than 4 years ago | (#29894357)

If drugs become targeted to certain DNA profiles, wouldn't it be likely that medical centers ask you to let them keep records of your DNA? Well, may be not your complete DNA, but certain genes. I wonder what could happen if such records go to the "wrong" hands, as health insurance companies.

Re:What about privacy concerns? (1)

zippthorne (748122) | more than 4 years ago | (#29895135)

Insurance companies aren't the "wrong hands." If the information exists, it will either be used by insurance companies to establish fair prices or patients to buy "insurance" when they already know they're going to exercise it.

Insurance is gambling. You can't give one party (or any party) the right to change the bet or make the bet after the cards are revealed.

"pre-existing conditions" are only a problem because, for some reason, insurance isn't structured such that the insurer you had at the time of diagnosis is responsible for that condition and its complications from then on. They should only be a problem for the people who aren't insured at the time of diagnosis, who should still be able to get insurance for everything else.

At time of diagnosis will eventually be quite early for genetic disorders. So there needs to be an option to have continuous coverage from the time of conception.

Re:What about privacy concerns? (1)

RDW (41497) | more than 4 years ago | (#29895351)

'Insurance companies aren't the "wrong hands."'

The US Congress (for example) begs to differ:

http://thomas.loc.gov/cgi-bin/bdquery/z?d110:HR00493:@@@L&summ2=m& [loc.gov]

Within the next decade, whole genome sequencing, which has already come down in price from several billion to $50,000 USD, is almost certainly going to become affordable enough to be used a a routine diagnostic procedure, enabling true personalised medicine (a '$1000 genome' is widely predicted). Do you think that filing your genome with an insurance company is placing it in the 'right hands'?

'"pre-existing conditions" are only a problem because, for some reason, insurance isn't structured such that the insurer you had at the time of diagnosis is responsible for that condition and its complications from then on.'

I believe 'for some reason' here translates as 'because it might reduce profits'.

'So there needs to be an option to have continuous coverage from the time of conception.'

You mean like this?:

http://www.nhs.uk/NHSEngland/aboutnhs/Pages/About.aspx [www.nhs.uk]

Re:What about privacy concerns? (1)

Ihlosi (895663) | more than 4 years ago | (#29895809)

Insurance is gambling.

Running an insurance company is as much gambling as running a casino is. In other words: Not very much.

Re:What about privacy concerns? (1)

BranMan (29917) | more than 4 years ago | (#29901667)

Insurance is NOT gambling. Insurance is a collective cushion against the acts of fate. If everyone in town puts $1000 into a fund so that if anyones house burns down they can use that money to rebuild it, it is NOT gambling. No one is betting they will have a fire, no one is betting they will not.

That's what insurance is. What an Insurance Company provides, however, may be different than that - they are out to make a profit, not provide that cushion. With enough random people, statistics provide the rates insurance should cost. Period. However, Insurance Companies take those statistics and then try to make sure they do NOT have a random insured base, to reduce the outflow. (let's give policies to only non-smokers - they're cheaper!) Hence more profit. Weaseling out of paying claims is also done, to reduce the outflow. Again, more profit.

If genetic information were used to set insurance rates, I wouldn't have much problem with it. Letting Insurance Companies use that info? Scares the crap out of me.

Re:What about privacy concerns? (1)

zippthorne (748122) | more than 4 years ago | (#29905485)

Insurance IS gambling. Gambling is a good deal for the Casino because the risk is spread over a lot of bets, so the fact that the Casino's edge might be 51% means that make a steady, small percentage of a lot of money. Insurance is good for the insurance companies for the same reason. It's also good for those who make the bet with the insurance company because they trade a finite, small chance of catastrophic costs for a known, steady, affordable payment over time.

If genetic information were used to set insurance rates, I wouldn't have much problem with it.

Ironically, I would have a problem with that. We need to let insurance be what insurance is, and make sure that *no one* can make the bet with substantially better information than the other. The Casinos shouldn't be able to know in advance who is going to win keno and choose not to make bets with them any more than the keno players ought to be able to only bet when they know they're going to win.

The solution is pretty obvious: start insuring patients at a stage before genetic tests are practical, and insure against the possibility of a disorder being discovered by said tests. If you've had continuous insurance, then you shouldn't ever have to worry about pre-existing conditions. If it predates your current insurance, your previous insurance should take care of it. If that's not the law, it ought to be, and insurance should be priced accordingly. No discounts for shady behavior.

If you haven't had continuous insurance, well, I suppose there ought to be some framework for mitigating that issue

Re:What about privacy concerns? (1)

Ihlosi (895663) | more than 4 years ago | (#29907619)

The solution is pretty obvious: start insuring patients at a stage before genetic tests are practical, and insure against the possibility of a disorder being discovered by said tests.

Err ... when would that be? Insuring right after delivery is probably too late. Insuring right after conception is too late, too, since they could just use genetic information from the parents.

As interesting as the plan sounds, I don't think it's feasible.

Re:What about privacy concerns? (1)

zippthorne (748122) | more than 4 years ago | (#29911645)

The only way I can see for the parents to have so many genetic disorders in common that it would raise the rate significantly above what others pay would be for the parents to be identical siblings.

Maybe in the future if there is one "super expensive" defect, we'll have to tweak the plan, but other than that, knowing the genetic information about the parents shouldn't give so much information that insurnace would be affordable for some and outrageous for others.

And as is the nature of probabilities, the most outrageous fees would apply to the smallest set of patients. Taking care of them "out of band" as it were, should not require completely changing the nature an entire industry.

Re:What about privacy concerns? (1)

Ihlosi (895663) | more than 4 years ago | (#29922207)

The only way I can see for the parents to have so many genetic disorders in common that it would raise the rate significantly above what others pay would be for the parents to be identical siblings.

It's not necessary for both parents to have those disorders (in fact, only few genetic disorders require this). A disorder can be x- or y-linked, or dominant.

In fact, both parents can be perfectly healthy and still have offspring with a genetic defect (e.g. colorblindness, which is x-linked. Women can have one defective x chromosome and still have normal vision, while men with the defective version will be colorblind).

Maybe in the future if there is one "super expensive" defect,

How about something straight out of a horror novel, like fatal familial insomnia?

http://en.wikipedia.org/wiki/Fatal_insomnia [wikipedia.org]

And as is the nature of probabilities, the most outrageous fees would apply to the smallest set of patients.

However, the insurers with the most stringent criteria can be the most profitable, essentially siphoning the cream of the customers away from insurers with less stringent criteria. Which in turn forces the latter to either charge outrageous fees from their remaining cusomters, adopt stringent criteria themselves, or go out of business.

Re:What about privacy concerns? (1)

zippthorne (748122) | more than 4 years ago | (#29937555)

Yes, but subsidizing an "insurer of last resort" for even fifteen million people is a lot less drastic than just taking over the entire industry.

Now, what's interesting is that there are a number of people who want to insure the uninsured with other people's money. If they really wanted to help the uninsured, they could create a fund right now with their own money to cover the costs of people who can't afford it.

People vote with their dollars for the things they really care about. Most people apparently don't really care about the plight of the uninsured, even if it means they're dying.

Re:What about privacy concerns? (0)

Anonymous Coward | more than 4 years ago | (#29897823)

Storing such data really isn't that difficult. Most of the genetic testing that's done this way is not done by sequencing out the genes, but rather by using a microarray (typically affymetrix). The array is basically a bunch of short DNA sequences complimentary to known gene variations, all stuck onto a glass slide. The DNA from a sample is isolated, and then poured onto the chip. If the sample has a copy of the sequence we're looking for, it will stick to the microarray at a very specific location. The chip is then read, noting the locations where DNA is and isn't bound. The result is a simple image file.
  Storing a simple image and the series number for the chip used alongside patient records is quite easy.
 
While this would allow easy perscription regimens to be made - i.e. give the patient drug $_Medicine if the array shows dots at $x1, $y1 and $x2, $y2; it would also be troublesome (as you pointed out) if insurers based their policies on the patterns of dots in the array.
 
One point worth noting is that this technique can only be used against known targets. It provides very little in the way of sequence data, and if some new drug targets a protein whose gene is *not* represented on the chip, you either make a new chip, run an individual diagnostic test for the protein (either ELISA or a PCR reaction), or you go back to trial and error.
 
TL;DR - genetic profiling is not the same as genetic sequencing. The genetic profile can be stored as a simple image file.

The Best Medications For Your Genes (1)

John Allsup (987) | more than 4 years ago | (#29894433)

Good Medications For Your may (or may not, at your option) include things like: food, beer, having a good time etc.

Unfortunately there is no obvious way of patenting that sort of thing in such a way as to be able to construct multi billion dollar corporations that have an uncanny knack of finding ways of getting government mandated things like the Medical Profession to cough up sums of money for problems that may or may not exist (since the existence questions must be legally sorted out by a Medical community that don't know enough about existential philosophy.)

I've seen this before somewhere... (3, Insightful)

L4t3r4lu5 (1216702) | more than 4 years ago | (#29894749)

... Oh yes; Gattaca.

Re:I've seen this before somewhere... (1)

AniVisual (1373773) | more than 4 years ago | (#29920967)

GATTACA may happen if this becomes a situation where drugs that are effective on only certain genes become really cheap, and no suitable substitute is available for those whose genes do not permit good medication.

It's used to hide steroid use by athletes (1)

tomhudson (43916) | more than 4 years ago | (#29894761)

Tamoxifen has been used since at least 1990 to mask the use of anabolic steroids by athletes.

Re:It's used to hide steroid use by athletes (1)

shiftless (410350) | more than 4 years ago | (#29903507)

Tamoxifen has been used since at least 1990 to mask the use of anabolic steroids by athletes.

I think you've got that wrong, unless this is an additional use I'm not aware of. Tamoxifen citrate, more commonly referred to in these circles by its original trade name Nolvadex, is a potent SERM (Selective Estrogen Receptor Modulator) which steroid users commonly use when coming off-cycle during PCT (Post-Cycle Therapy.) While their natural testosterone production is recovering, SERMs help block a number of unwanted side effects that would or could otherwise occur due to high estrogen levels. It may also be used while on-cycle if estrogen-related side effects were to develop.

Re:It's used to hide steroid use by athletes (1)

tomhudson (43916) | more than 4 years ago | (#29915569)

No, don't have it wrong. I worked in a pharmacy back in the early '90s, and one of the weightlifters who got his steroids elsewhere (we wouldn't sell steroids to him, but syringes are available to everyone who wants under a government program that's intended to reduce needle sharing among druggies) was using tamoxifen to mask the steroids, and it worked. He always tested clean.

I thought it was funny because he came in a day after an interview with him made the local paper, where he said he didn't use steroids. I bugged him about it - he said "What was I going to say, tell them the truth?"

Why Where and When? (0, Flamebait)

DynaSoar (714234) | more than 4 years ago | (#29895177)

Of course Forbes is known as a health care consumer advocate, not a source of data useful for strategic and tactical planning by corporations. Therefore they've put this article together so that we, the consumers, will seek the best possible care by consenting to the genetic testing offered, allowing them to select the best drugs for us rather than waste our time with less effective ones. There's no way any of those health care sources could misuse such information because the law forbids it, so when they start ranking their drugs as to efficacy in various genotypes, they'll make it entirely our decision whether to pay for the best our insurance will allow us to have using shot in the dark medical treatment which would be considered experimentation on human subjects if it weren't so ingrained in our minds as acceptable medicine, or whether to request the genetic testing they make available as a service so they can help us select the most effective drug for us, something the insurance companies will be sure to support. And when the insurance companies decide it's time to raise the malpractice insurance rates again, those doctors who support genetic testing and use it to select medications will find that their policies will cost less if they take the precaution of testing their patients first rather than play Pharma roulette with their treatment.

Very, very few drugs do or can react differently enough according to the genetics to make it worth taking the trouble. But since a very few do, many will get tested. Whether or not there is a practical difference, a statistical difference can be forced making it seem as if more and more drugs can be dispensed according to this tactic. During the coming lobbyist/marketoid paroxysm of profit seeking wearing the Easter Bunny suit of consumer advocacy they enjoy so much, we will be bombarded with advertising (and the medical community with far more) showing us how this is all benefit to us, and care & concern on their part. Afterwards there will be genetics rankings on myriad products, and more and more treatment decisions will be based on these. There will be adequate statistical (as opposed to real) evidence supporting the use.

It will come from providers, and it will be our decision to accept it. They fully expect us to despite the fact this has been outlawed as long as it's their decision. There can be no huge FDA backlash because making them do an entire clinical series on the genetic aspect also will make drugs take even longer than the present too many years to get to market and cost yet another digit of price when they do. And when it is said and done, all medicine (after the gigantic increases in a few areas get smoothed out by filtering them through the industry) and treatment will cost more. How much more?

Enough to make up for what they'll lose in the coming health care 'reform' if they don't. This is, in effect, the health care industry acknowledging they lost the first battle in the war. They tried to say that prices and premiums would go up for the insured if this reform went through; they were called down on it since they are the one who set prices, making their statements essentially threats. That marketoid scheme backfired and cost them the battle. Now they're firing over our bow a tactic with which they can discredit as contrary to their stated purpose of saving consumer's money anyone who tries to stand between them and consumers, thereby forcing the appearance (at first) of alliance between them and consumers, stealing consumer hearts and minds back from the consumer advocacy groups and the few government officials that actually were trying to change things for the better. Once they're recaptured, re-enslaved and re-addicted enough consumers they can set this alternative plan in motion, and let the 'reform' go through. The alternative will allow them to make even greater profits within this new structure, polish their tarnished images in the public eye, forge new and reforge damaged bonds between themselves and key government agencies and officials, and get back to the business that outgrew national defense 30 years ago.

I have to admit they're doing a fine job for being out of practice at this level. During most of this decade they could count on the administration to make far more noise with far less rational thought, and then dare critics to try to go up against their parroting heads on the news and analysis shows to get their cockles handed to them. On their own, against a hostile administration and public sentiment, they scuttled their flag ship when their flag turn up with brown stains and are coming back planning to replace the defending army in the eyes of the citizenry, save the nation, and replace the government with deposit-only banks. Balls, brains and nuclear bombast. Got to admire the fucking leeches.

I could have been one of them. I got the degree 15 years ago. I'd be much richer now. Unfortunately I'm predisposed to a mental condition called conscience. But I can at least understand it well enough to enjoy what amounts to a small scale war within my own country, the only damage being financial on the part of the players. No matter who loses, costs will be covered by changing the amounts charged and or shifted in future care, and the people will lose. But since that would have happened in any case (except complete disruption of health care delivery; believe me, they're going to threaten it) I can sit back on my aging and increasingly infirm ass and watch a show that puts professional sports to shame. To shame how? If you bet on a game, you either win and get paid, or lose and pay out. With these people, win or lose you pay.

If I let on here half of what I knew I'd have a string of followers waving tinfoil hats at me. But that's just the nature of amateurs. When I went full bore against a very small piece of the industry regarding research and treatment of a condition that isn't harmful (perhaps socially uncomfortable in that others stare at it) and being entirely genetically determined at birth can't possibly be treated, I got treated as a professional. Letters from top name researchers and their university presidents claiming I was costing them millions in research grants (copies to my university president), investigations into my research (both the science and grants) to see if they could flip those boats. Letters saying the above was being done (guilt by accusation) sent to previous schools and employers, trying to dirty my reputation and make good references from them appear suspect. Real effort put forth by people to whom it really mattered; people who get grant money to do something useless. So wave those tinfoil hats folks, you've already been outplayed by pros, and I have no problem showing my ass in public and dancing the happy dance anyway.

Re:Why Where and When? (4, Informative)

blackbearnh (637683) | more than 4 years ago | (#29895355)

I'm not going to argue about the mysterious information you have, since you don't go into details on it, but as the author of the article, I should tell you that it's part of the "O'Reilly Insights" series, not a straightline Forbes piece, and I very much was writing it from the perspective of "here's a significant piece of medical advancement that will affect us as individuals, and is also going to make drastic changes in the pharma industry.

You say that there aren't enough drugs that genetic variance makes a difference in, and it's all a big scam to get people's data. Personally, I think that major differences in the effectiveness of the leading breast cancer drug, and huge variance in the uptake of the most commonly prescribed blood thinner, are pretty significant, and I'm damn glad I know that I overmetabolize Coumadin, because I could very well be in an ER with a stroke some day.

We're just in the very earliest stages of looking at how genetic variation affects medicine, and once we start to build a larger database of fully sequenced individuals, I'm sure we'll find more and more cases of genome-influenced variability.

And for the record, I'm an applicant to the Personal Genome Project, which is about as public a distribution of genomic information as you can get, so I am certainly putting my money where my mouth is as far as choosing the benefits of greater knowledge over the fear of discrimination.

Old news, but hey, it's news. (3, Informative)

TheMohel (143568) | more than 4 years ago | (#29895321)

The FDA has had a table of valid genetic biomarkers for medications [fda.gov] for several years now. While many of these are cancer drugs looking at specific metatabolic or receptor issues, our old friend warfarin (a "blood thinner" with a narrow therapeutic index, a reputation for causing a lot of trouble and a genomic profile that accounts for about half of the known variation in the drug) and the pain drug codeine are on that list as well. There's even a research website [warfarindosing.org] devoted to genetic calculation of warfarin dosing.

Carbamazepine (Tegretol) can cause a rare life-threatening reaction called Stevens-Johnson Syndrome (Toxic Epidermal Necrolysis), but it's mostly limited to individuals with a specific Human Leukocyte Antigen (HLA-B*1502). Again, known for quite a while and a part of the basic biology of the drug.

It's a fairly well-written article, but it's kind of breathless about stuff that I was really excited about back in the '90's when my medical school teachers were really excited about it too. The best news is that the FDA has really stepped up in the past few years to make this actionable data that a practicing clinician can use.

Re:Old news, but hey, it's news. (1)

ShakaUVM (157947) | more than 4 years ago | (#29898771)

>>The FDA has had a table of valid genetic biomarkers for medications for several years now.

Yeah, exactly, this isn't really new news. When my wife started pharmacy school at UCSF in 2004, she took a class on pharmacogenetics, the study of how your genes affects how you interact with the drugs. CYP4, as TFA mentions, is one of the most important liver enzymes, but there's a lot of differences in populations due to genetics.

Alcohol Dehydrogenase and another liver enzyme (that I can't recall off the top of my head) are the two primary ways alcohol gets broken down in your system. There's very major differences between races if they have the gene that codes for it. Irish and German populations have close to 100%, whereas in countries like China and Japan the rates are much lower, something like 40% and 20%, respectively. I recall people studying that back in 1995, when I was an undergraduate at UCSD - they'd put fliers up around the campus saying, "If you're asian, and you're over 21, we'll pay you to come to our lab and drink free beers." Damn racists.

A lot of people claim that human races don't exist, saying that we're all genetically indistinguishable. While the idea is a noble one, it is not actually true, and would actually harm valid research and medical outcomes.

Re:Old news, but hey, it's news. (0)

Anonymous Coward | more than 4 years ago | (#29900961)

A lot of people claim that human races don't exist, saying that we're all genetically indistinguishable. While the idea is a noble one, it is not actually true, and would actually harm valid research and medical outcomes.

As you point out, there are distinct genetic clusters in the human population that correspond to geographic origin, and this fact is highly relevant to medicine.

However, this fact is not in conflict with the idea that "race" is, in large part, socially constructed, because the race concepts that inhabit the mind of, say, an average American, do not correspond particularly well to these genetic clusters, or to, for example, the race concepts of somebody living in a particular region of Africa.

I remember one enlightening moment in a PBS documentary from a few years ago, where Henry Louis Gates, Jr. (yes, the same one who was arrested in front of his home) was interviewing an African man with significantly darker skin than Gates himself. The man insisted he was not black—not only was he Arab, he harbored a notion of his own superiority to "black" people. But, if I saw him—or Mr. Gates—walking along the street, I would instinctively categorize him as black, plain and simple.

If we for some reason wanted our notion of race to correspond to these genetic clusters—and there's no particular reason why a basically social notion should be expected to correspond in this way—this is particularly difficult for African-Americans. Why? There's far more genetic variation within Africa than outside of Africa, and we'd have to divide African-Americans into far more clustered subgroups than, say, European-Americans, but the socially constructed notions of race correspond simply to "black" and "white."

The point is: (1) you can, in fact, categorize humans into groups based on genetics, and (2) those groups are not the same thing as race in the conventional, everyday sense.

Relevant Wikipedia articles with long lists of references: Human genetic variation [wikipedia.org] ; Lewontin's fallacy [wikipedia.org]

Mostly for cancer therapies only (1)

toppavak (943659) | more than 4 years ago | (#29895635)

It should be noted that this kind of "personalized medicine" as it tends to be called is mostly only relevant to cancer treatments that inhibit certain receptors or enzyme, as tamoxifen does. Typically there are cancer subtypes that, while they may look alike, are actually caused by a different mutation than the one that the anti-cancer drug targets.

Tailored to your Genes? (0)

Anonymous Coward | more than 4 years ago | (#29896887)

BiDil [bidil.com] comes to mind...

Cuustom Meds (2, Interesting)

Pedrito (94783) | more than 4 years ago | (#29898247)

Where this will really come into its own is, down the road, where custom medications will be created specifically for your genetic profile. That is, they'll create a custom drug that fixes your problem but won't cause side-effects. This isn't tomorrow or 5 or 10 years from now, but more like 30-40 years from now. Creating a custom drug in a lab right now would be a major ordeal and very expensive, but with advances in biochemical modeling and automation, this can be overcome. By analyzing the genes, however, a custom drug can be developed that, not only works with your individual version of whatever proteins might be involved, but it can also be modeled against other genes/proteins to avoid potential side-effects, providing efficacious and side-effect free medication.

Re:Custom Meds (0)

Anonymous Coward | more than 4 years ago | (#29898767)

To some extent, personalized designer treatments are already being created. About a year ago I interviewed with a company specializing in this sort of thing: http://www.argostherapeutics.com/ [argostherapeutics.com] . (Disclaimer: no, I didn't get the job, and no, I'm not plugging for the company). Basically what they were doing was taking a patient's cancer sample, breaking down the cells, and then electroporating the components into the patients FDCs (follicular dendritic cells). The FDCs are then reintroduced into the patient, and from there, present the antigens from the cancer sample and induce an immune response against them.
 
  Basically it's a method to teach a person's immune system to attack their specific cancer. Functionally, it's closer to a therpeutic vaccine than a drug. As far as I know, this is the closest working example of personalized medicine we have.

Even more interesting - (2, Informative)

jhfry (829244) | more than 4 years ago | (#29901389)

From TFA:

There have also been a number of drugs under development, which were abandoned because they only benefited a small percentage of patients (say, for example, 30% of a hypothetical new drug), while carrying significant side effects. But just as those 10% of cancer patients got no benefit from tamoxifen because of a genetic variation, it might be the case that the 70% who didn't benefit from our hypothetical drug did so because they didn't have the correct genome. If we could identify the 30% that it worked for, what was once viewed as a failed drug could instead be a miracle drug, albeit for a subset of the entire patient population.

Imagine the research opportunities here. The R&D was done, the drug worked wonders in a small subset of patients and failed catastrophically in others... lets find out WHY. This idea could employ tens of thousands of researchers for several years just pouring over old trial data, running new trials, and linking genetic research to drug research.

I know if I were a pharma company I would be ramping up a similar effort. A good example is Elan's Tysabri, which was hailed as a wonder drug for many MS but faced major delays in light of a number of patients dying during trials... which nearly killed the company. A little genetic R&D and they may have been able to pinpoint those people who should not take the drug... allowing it to fly through FDA approvals.

ha ha he he heh heh heh yowling on the floor (1)

ImitationEnergy (993881) | more than 4 years ago | (#29912619)

You actually think any Roanoke Virginia doctors give a shit? You have got to be kidding me. The few glaring medical issues that have been keeping me from returning to work and they call them Electives, and keeping me in a revolving door staying disabled when I could return to work, so they can continue feeling like medical wonder gods and He-Man Physician of the Universes, and they're going to HELP ME? hahahahahahahaha So far I have cost the American taxpayers about $230,000.00 so these doctors wouldn't treat me successfully, and YOU knucklehead you think they will use this information? They aren't trying to heal people they keep people sick, keep people overweight, because it KEEPS THEM A STEADY WONDERFUL PAYCHECK. You're making me laugh so I thank you for that but sir, friend, whoever you are, you have a poor grasp of how the Commonwealth of Virginia operates as a communist outpost a take-off on Cuba. All we lack here is Fidel Castro and I expect him to arrive shortly. The lawyers operate as a communist bunch in cahoots with the physicians and hospital Board of Directors (ex railroad men) to always turn a profit and they back each other up if one makes a mistake the others cover it up by saying No, he made no mistake. hahahahahahahaha They even passed a Law that keeps any malpractice lawsuits from getting a fraction $$$$ of what the patient should receive. Damn, everybody here in Virginia knows the score and they know not to complain because it does no good, because complaining to an attorney who is in the doctor's back pocket achieves NOTHING. Welcome to Communist Virginia, and I advise you to stay the hell out of here, stay in a real state. Truck drivers should refuse loads into Virginia unless they get double pay, because if they are hurt here as I was they may as well eat a shotgun shell. A Monopoly exists here, a professional monopoly not a business monopoly, and you better learn that boy.
Check for New Comments
Slashdot Account

Need an Account?

Forgot your password?

Don't worry, we never post anything without your permission.

Submission Text Formatting Tips

We support a small subset of HTML, namely these tags:

  • b
  • i
  • p
  • br
  • a
  • ol
  • ul
  • li
  • dl
  • dt
  • dd
  • em
  • strong
  • tt
  • blockquote
  • div
  • quote
  • ecode

"ecode" can be used for code snippets, for example:

<ecode>    while(1) { do_something(); } </ecode>
Create a Slashdot Account

Loading...