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7 Things to Know About Pharmacogenomics

By U.S. News & World Report

We all know a medication that works well for one person might not work for another — or even cause some people unwanted side effects. These differences in response can be caused by factors such as age, gender or other drugs and supplements that a person might be taking.

However, up to 99 percent of us may have small variations in our genes that can also impact how we react to common medications, including pain relievers, antidepressants and blood thinners.

Now, through a new kind of genetic testing in a field known as pharmacogenomics, some doctors are able to identify a number of these variations to help predict how their patients might respond to a new medication.

These tests are very different than genome sequencing services that provide data on your ancestry, analysis of disease-related genes or information on your risk of developing certain diseases. Instead, the tests look for specific gene variants that can help physicians minimize the trial and error of prescribing certain medications and help narrow down medication choices, especially when it comes to treatments for pain and psychiatric medications.

When I helped open the pharmacogenomics clinic at NorthShore University HealthSystem in Evanston, Illinois, in 2015, it was the first hospital-based pharmacogenomics clinic of its kind. Now, a small but increasing number of doctors and health systems are offering this testing to patients. Some direct-to-consumer testing companies also offer pharmacogenomics tests.

However, pharmacogenomics is a relatively new field, and not every doctor has access to a pharmacogenomics test or knows how to interpret the genomic information. Additionally, only about 20 percent of the drug market has been impacted by pharmacogenomics so far. For many medications, a pharmacogenomics link has not yet been found or doesn’t exist.

Understanding the basics of pharmacogenomics and how it differs from other genetic tests can help you decide whether or not these tests could be a useful tool for you and your doctor. Here’s what to know:

1. Pharmacogenomics will not tell you why your eyes are blue or predict your risk of cancer. Unlike other genetic tests, pharmacogenomics does not measure disease risk. Instead, it helps doctors identify treatments that are most likely to work by examining how your genes affect your response to medications.

[See: 5 Common Preventable Medical Errors.]

2. The tests cannot give information about how you may respond to every single medication. Currently, research only supports testing for certain drugs, most commonly those for cardiology, pain management and depression/mental illness.

3. A pharmacogenomics test has value throughout your life. By studying a set of your genes, clinical experts can analyze a broad amount of information regarding drug therapy for many conditions, including psychiatric disorders, pain management and cardiology. Because your genes don’t change over time, you only need one test to discover genetic information that could be applied to future care. At some hospital-based testing centers, results can be added to your electronic medical record for easy access and used as a reference for medication and treatment choices throughout your life.

4. Pharmacogenomics is especially helpful for non-responders — people who have tried numerous drugs to find ones that effectively treat their symptoms. For some people, the tests can help explain why they didn’t respond to medications in the past, or provide peace of mind in knowing they are not genetically predisposed to a negative outcome on a new medication.

5. To make the best use of pharmacogenomics testing, have a goal in mind. Make sure that the medications covered by the genes being tested are related to your current clinical situations or medications you and your doctors are considering for future use. For example, if heart disease runs in your family, the goal of the test might be to look at the genes related to cholesterol lowering or blood thinning medications, as your doctor might consider these in your future care.

[See: How to Help Aging Parents Manage Medications.]

6. Pharmacogenomics is “not a crystal ball.” While it could determine why your medication isn’t working and help narrow down your options, it won’t tell you the perfect drug for your condition or provide information on drug-drug interactions or drug supplement interactions. Rather, it can narrow down your options and help doctors prescribe the right medicine faster.

7. With diagnostic tests, sometimes no news is good news. Often doctors recommend the genomic testing to rule out genetic factors as the culprit if there are concerns about medication response. No specific feedback from your genomics test means that your suboptimal response to a particular medication is not the result of your genetics, but could be caused by other factors such as diet or age.

At our pharmacogenomics clinic, testing is a two-day process that begins with a session to lay out considerations for the patient. We discuss the benefits, limitations, risks and cost so the patient can make a value-based judgment with a clear understanding of what information the test will and won’t provide.

[See: 10 Lessons From Empowered Patients.]

Especially when it comes to pain medication and psychiatric medications, pharmacogenomics testing can minimize the trial and error of prescribing medications, plus help a physician to narrow down treatment choices. For some people, knowing can mean a lot. For others, it just might not be valuable for their particular situation or condition. If you think pharmacogenomics testing could help you, work with a clinician who has expertise in analyzing pharmacogenomics test results for your particular condition or who can partner with pharmacogenomics experts. This is the best way to determine whether this particular type of genetic testing is likely to provide you actionable results or peace of mind.

Mark Dunnenberger, PharmD, leads the nation’s first dedicated pharmacogenomics clinic, started last year, within the Center for Personalized Medicine at NorthShore University HealthSystem in Evanston, Illinois.

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7 Things to Know About Pharmacogenomics originally appeared on usnews.com

Don’t Settle for Student Loans to Pay for Online Education

By WTOP Staff
Online college programs are becoming a more popular choice for prospective students, with one study finding that more than 6 million students enrolled in at least one online course in fall 2015. The popularity of these courses can be attributed in part to their flexibility with working adults' schedules, students' ability to progress more quickly through online programs and, oftentimes, cheaper tuition. [See 10 low-cost online bachelor's programs for out-of-state students.]Online degrees can be beneficial to many college students, but some studies have shown online learners complete their programs at lower rates than students at traditional brick-and-mortar campuses. Individuals with student loans but no degree comprise two-thirds of defaulted borrowers. Though these numbers are not encouraging, just like for traditional programs, there are ways to reduce how much you'll need to borrow for an online program to ensure you won't become one of these statistics. Don't just settle on borrowing student loans to cover the whole cost of your program and living expenses. Instead, start thinking about how to cut costs and cover your balance in different ways, such as the following. -- Grants and scholarships: Even though you are taking an online course, you can still apply and receive grants and scholarships. But your first step should be to complete the Free Application for Federal Student Aid, commonly referred to as the FAFSA, which will allow you to receive a Pell Grant if your expected family contribution is low enough. The EFC criteria and award amounts are adjusted annually, but the 2017-2018 academic year awards range from $606 to $5,920, which could significantly lower the amount you borrow annually. Your next step is to apply for scholarships. You can start by checking online scholarship search engines, such as the Salt Scholarship Search, College Board's BigFuture and Peterson's. But don't forget to take advantage of local organizations and your school's financial aid office. Both may offer scholarships that you can't find with a national scholarship search. [Review these 10 sites to kick off your scholarship search.]For instance, organizations like the Elks Club, Knights of Columbus or the Rotary Club typically offer scholarships annually to local students. Just because you're going to school online doesn't mean you're ineligible. Visit your local library for scholarship listings, and ask around town. You might be surprised how many local organizations offer scholarships. While these scholarships typically aren't large, every little bit counts. Each dollar you receive in a scholarship is a dollar you don't have to borrow and pay interest on. -- Work-study: Another option for online students may be work-study awards. Not all students enrolled in online programs are eligible, but students at some schools -- including, for example, SUNY Empire State College and Liberty University -- are. Work-study awards are not given upfront like scholarships and grants. In most cases, they are an offer to earn up to the awarded amount if you secure an eligible work-study job. While there is a misconception that all work-study jobs must be on campus, students can work for off-campus, nonprofit or public employers as long as the work is in the public's interest. You may be able to work for a for-profit employer if the job is relevant to your course of study. No matter who the outside employer is, it will need to have an established agreement with your college for you to receive work-study funds. Remember, to be eligible for federal financial aid, you must be enrolled and pursuing a degree or certificate. If you're not working toward a credential, Pell Grants and work-study won't be option, but you may still be able to take advantage of private scholarships -- just be sure to read the eligibility criteria carefully. [Explore what to know about financial aid in online programs.]-- Pay as you go: One of the great benefits to enrolling online is the flexible schedule, which can allow you to complete your college coursework around your responsibilities. But prospective students often overlook using their part- or full-time job earnings as an option for paying for college. Almost 80 percent of college students in 2015 worked at least part time while attending classes, according to the National Center for Education Statistics. By budgeting and thinking strategically about your college costs, you can likely reduce your dependence on student loans by paying a portion out of pocket. Many -- but not all -- online programs are less expensive than traditional programs and often have shorter payment periods. Six, eight or 10 weeks are common course durations. Because of the frequency of payments in an online setting, you may be well-placed to pay as you go and possibly avoid borrowing altogether. Attending college online and avoiding student loans may be challenging, but if you are willing to put in the effort, you can limit the amount you need to borrow. More from U.S. News Q&A: Understanding Student Loan Discharge Eligibility Student Loan Refinancing Isn't Right for All Borrowers
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