CMT | INDUSTRY POSITION STATEMENT: Use and Application of Pharmacogenomics Inside Concierge Medicine
Concierge Medicine Today (CMT) Issues Statement of Support For Use and Application of Pharmacogenomics Inside Concierge Medicine
“Comprehensive Pharmacogenomics is a powerful healthcare innovation. Concierge Medicine provides the ideal delivery model for the future of predictive medicine,” says trade publication, Concierge Medicine Today. “Used under the guidance and application of a Concierge Physician, these tests can have a predictive effect on patient treatment outcomes, find adverse interactions and help to manage prescription dosages. Comprehensive screenings with more than 50 well-established pharmacogenomic genes in a single, cost-effective test can provide medically actionable and clinically relevant data, allowing Concierge Physicians, to make a more informed and thoughtful treatment recommendation for the health and well-being of each patient. Concierge Medicine Today strongly supports use of this innovative testing.”
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FEBRUARY 7, 2017 | ATLANTA, GA – Concierge Medicine Today issued a statement of support for the use and appropriate application of Pharmacogenomics under the guidance and direction of a Physician. “Pharmacogenomics aims to predict how individual genetic variability impacts drug absorption, metabolism and activity,” said Catherine Sykes, CEO and Publisher of the national trade publication. “Concierge Medicine Physicians are the ideal delivery mechanism for this comprehensive testing.”
Pharmacogenomics is the combination of pharmacology and genomics. It involves the study of genetic variations that influence an individual’s response to specific drugs. Pharmacology is the part of science that studies how drugs work. Genomics is the study of a person’s genome including the interactions of those genes with each other and with the person’s environment. Just as decision aids now alert prescribers that the patient takes a supplement that may interact with a prescription, these tests would alert the physician and prescriber that the patient is a poor metabolizer of a particular drug. While one pharmacology treatment approach may work well for one individual, the same approach may not be effective or may cause adverse drug effects in other patients. The implementation of pharmacogenomics helps physicians make informed treatment decisions. This can lead to better patient outcomes by decreasing adverse drug events and by increasing the effectiveness of drugs using data, research, science and the analysis and interpretation of the data by a licensed Physician.
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The notion of individual genetic variability has long been accepted and promoted within both the scientific community and the healthcare industry. Advances in molecular testing, and completion of the mapping of the human genome, in particular, give credence to the fact that patients respond differently to medications based upon their individual genetic makeup. Such advancements brought about the concept of personalized medicine, the practice of using an individual’s genetic profile to guide decisions for the prevention, treatment, and diagnosis of disease. Correspondingly, a major problem in the managed care industry is the variability of drug efficacy from patient to patient. While some patients complain about lack of effectiveness, other patients suffer from adverse drug events (ADEs). Personalized medicine has the ability to alleviate the burden of individual genetic variability and the resulting varied drug responses across different patient populations. Patient non-adherence to medications as prescribed is a significant economic burden; the resulting estimated annual healthcare costs are close to $3 billion in the United States. The benefits of pharmacogenomics testing to patient adherence are frequently overlooked. Patients fail to take their medications for a number of reasons, such as the general sense that the medications do not work and anxieties related to the possible side effects listed within drug labels. For the non-adherent subset of the patient population, pharmacogenomics testing can serve as positive reinforcement and incentive for patients. Pharmacogenomics test results provide personalized, actionable facts for patients.
“Pharmacogenomics is breakthrough, next generation science which allows Physicians to target an individual with the very best personalized therapy based on their own genetic information,” said Zeil Rosenberg, M.D., Vice President, Medical Affairs, Admera Health. “What was science fiction 10 years ago is here today, thanks to major advances in medicine and information sciences. With an increasing thirst for information by patients, this knowledge translates in clear and immediate clinical benefits.”
Concierge Medicine Today cautions that in order to make this information actionable for patients, a Physician must fully integrate pharmacogenomics into system-wide prescribing practices. After years of thoughtful consideration, careful research and review and countless hours of dialogue with various physicians and companies, we recommend Concierge Medicine Physicians begin to make personal genomic data information and tests available to patients. However, the type of test matters. There are a number of offerings in the marketplace with more to come in the years ahead as these tests become more mainstream. Comprehensive screenings with more than 50 well-established pharmacogenomic genes in a single, cost-effective test will be able to provide medically actionable and clinically relevant data, allowing Concierge Physicians and their patients to make more informed and thoughtful treatment decisions.
“This is an important next step in medicine,” said Sykes. “It is critical that patients and their advising Physician(s) begin to learn more about a person’s individual genome. Medical science is advancing more rapidly than we’ve ever seen, outpacing what a Physician can possibly know about adverse drug interactions based on genotype. There are tests available and becoming increasingly more affordable that determine how patients will respond to drug therapy for a number of therapeutic areas, including psychiatry, pain management, and cardiology.”
Patients need only to be tested once, as genetic information does not change over time. Therefore, genetic testing results have lifetime utility. As hospitals roll out pharmacogenomics programs in the coming years, patients will likely undergo tests for genetic variants known to play a role in the metabolism of a drug their Physician plans to prescribe.
As genetic testing becomes less expensive, more accessible, and generally, more common, Mark Dunnenberger, PharmD, Director of the Pharmacogenomics Program at NorthShore University HealthSystem in Evanston, IL. envisions in the near future that many patients’ medical records will already include a patient’s raw genetic data.
“We need to build a system that allows us to pull out what we need at the moment that we need it and make clinical recommendations,” Dunnenberger said. “That changes the question from ‘Should I test you for this or for that?’ to ‘Let me go find that piece of data.’ That’s going to be really powerful if we build the informatics tools to support that.”
Pharmacogenomics is also integrating into EMRs. The NorthShore University HealthSystem is among just a handful in the nation which focuses exclusively on pharmacogenomics. NorthShore, with three hospitals, is the very first group to achieve Stage 7 on the HIMSS Analytics EMR Adoption Model. 
The American Medical Association (AMA) recently said of Pharmacogenomics, “Pharmacogenomics has the potential to provide tailored drug therapy based on genetically determined variation in effectiveness and side effects. This will mean:
- More Powerful Medicines – Pharmaceutical companies will be able to produce therapies more targeted to specific diseases, maximizing therapeutic effects while decreasing damage to nearby healthy cells.
- Better, Safer Drugs The First Time – Recovery time will go down and safety will go up as the likelihood of adverse reactions goes down or is eliminated, altogether.
- More Accurate Methods Of Determining Appropriate Drug Dosages – Current methods of basing dosages on weight and age will be replaced with dosages based on a person’s genetics –how well the body processes the medicine and the time it takes to metabolize it.
Concierge Medicine Today supports Concierge Medicine Doctors in working with pharmacists and pharmacogenomic companies to develop clinical decision support tools that will assist and guide prescribers in the use of pharmacogenomic information. Concierge Medicine Today further supports them in preparing and distributing materials for patient education and beginning to frame institutional guidelines for pharmacogenomic implementation inside local hospitals and specialty offices.
Concierge Medicine Today encourages Concierge Medicine Physicians and the provider community to work with local pharmacists to lead the clinical application of pharmacogenomics. Collaborating together, as part of a safe, effective, and cost-efficient medication practice. Furthermore, to prepare all Concierge Medicine Physicians and staff to provide Pharmacogenomics testing and recommendations, Concierge Medicine Today calls on more State Associations, colleges of pharmacy and the Board of Pharmacy Specialties (BPS) to include curriculum about this growing field.
“What would happen if Physicians were able to begin making treatment recommendations based upon a patient’s genotype?” notes Sykes. “Concierge Doctors are in the habit of spending an inordinate amount of time with their patients, many of whom have significant and serious health concerns. What would happen if we intentionally connected [Concierge] physicians with new scientific technologies that could enable them to deliver more high precision treatment recommendations and provide more accurate prescribing to their patients? We aim to find out.”
Finally, Concierge Medicine Today believes, as do pharmacy organizations, that pharmacogenomics is primed for continued growth.
About Concierge Medicine Today
Concierge Medicine Today (CMT) is a news organization and the Concierge Medicine industry’s oldest national trade publication for the Concierge Medicine and Membership Medicine marketplace. Its web site is the online destination for businesses, consumers, physicians, legislators, researchers and other stakeholders to learn about the history of this industry, various business aspects of the marketplace, trends, breaking news and more that drives the conversation that Concierge Medicine and free market healthcare delivery is creating on a national and international level. For more information, visit: http://www.ConciergeMedicineToday.org
-  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934668/
-  http://www.admerahealth.com/faq-items/physician-faq/
-  https://www.pharmacist.com/pharmacists-called-take-lead-pharmacogenomics-bridge-personalized-medicine
-  https://www.pharmacist.com/pharmacogenomics-coming-emrs
-  http://www.ama-assn.org/ama/pub/physician-resources/medical-science/genetics-molecular-medicine/current-topics/pharmacogenomics.page
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