Gene Testing Could Provide More Accurate Prescribing for Injured workers – Someday

Nancy Grover

Sarasota, FL (WorkersCompensation.com) – Imagine going to your physician and getting the exact medication and dosage you need immediately. No need to try several different drugs to find out which one works best to treat your pain, or which antibiotic will cure your sinus infection. The physician would know what medications and how well your body could metabolize them — all from a simple blood test.

Called pharmacogenomics, it is the study of how a person’s genetic makeup affects his body’s response to drugs. While not commonly used yet, it is likely just a matter of time.

“The day will come when it becomes the standard of care. But we are not there yet,” said Phil Walls, Chief Clinical Officer for myMatrixx. Walls will join William Franken, Corporate Risk Manager of Seaboard Corporation for the session Pharmacogenomics: Is DNA the Future of Minimizing Risk from Adverse Drug Reactions, at the Risk & Insurance Management Society’s annual conference in Boston.

Pharmacogenomics

“To me, pharmacogenomics is the future of prescribing,” Walls said. “But the reason I want to do a presentation now is I’m already getting questions from clients, and I just want everybody to be ready for when it comes.”

One reason Walls believes the day of pharmacogenomics is coming soon is because of the dramatic price reductions for the testing. Where it once cost thousands of dollars, it is now more in the neighborhood of a few hundred.

The pharmacogenomics ‘test’ needs to occur only one time, since a person’s DNA doesn’t change. One of the problems, however, is who would pay for that test.

“Should workers’ compensation be paying for it today? That can become a complicated question,” he said. “This is a once-in-a-lifetime test. So if group health has paid for it, which they have not, but when the time comes that they do, should workers’ compensation have to pay to repeat the test? That doesn’t make sense. However, it’ll be up to the patient as to whether they share the information. That’s where it gets complicated. … The patient must be willing to share the information. That’s the only way around HIPAA.”

Injured workers may not want that type of information to be shared with the employer. But could the employer be bypassed and the test go directly to the insurer? It’s one of many complicating questions.

Nevertheless, the test could prove valuable in the workers’ compensation system if, for example, it is used to determine a person’s ability to metabolize opioids, anti-depressants and anti-psychotic medications.

One thing the test cannot predict is whether an injured worker is likely to become addicted to an opioid. “I’ve had people ask me while I’m out traveling, ‘I’ve heard there’s a new test to see if someone is an addict?” Walls said. “No, the science is not that far progressed. Can it get there? Maybe. But only if we determine addictive behaviors are genetically related. We don’t know that at this time.”

What the pharmacogenomics test can identify is:

  • People who cannot metabolize a particular type of drug
  • Those who metabolize a drug slowly
  • Patients who metabolize a drug rapidly

“The dosing needs of a patient would help a physician determine which of those three variants they fall into. That’s where things get complicated because we’re dealing with pain,” he said. “It’s not like blood pressure; we, must rely on the person to say [the medication] is helping or not. Then we have all the factors that go into pain management.”

Measuring a person’s pain is a complicated process. Not only might the injured worker have his own motives for saying a drug is or is not working, but an attorney involved could have an agenda, as could a prescriber.

“But in an ideal situation where the prescriber is trying to do the best thing for patient I can see it would have value to an injured worker,” he said. “But are we there yet? No. I don’t think most physicians have application for testing yet.

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