So, the process starts with a patient who is unhappy with a medication they are taking. Unhappy in this case could mean that either the medication is not working how it is supposed to work or it is giving the patient undesirable side-effects. So, they are recommended by a healthcare professional to participate in the First Vitals study (which is covered by insurance at the moment), so they come into the endocrinology office where I am interning. The patient fills out a survey where they are asked various questions about the medical problems they have and the drugs that they are upset with (this survey is the pre-PGX data). We then swab their mouth and this mouth swab is sent to some other location where their genome is tested for the presence or absence of 12 specific genes. Then based on the results from the genetic testing, healthcare professionals from the endocrinology office work with the people who tested for the genes to see why the patient's medication is not working properly but now in the context of those twelve genes. After this analysis is made, alternative recommended treatments are provided to the patients and then the patient can take that information to their regular doctor and ask for the new treatment. 90 days after the initial mouth swab, the patient comes in again and fills out a survey to determine if this alternative medication worked better (this survey is the post-PGX data).
So, my job for this first week was to input the pre-PGX data into a website so that specialists can later analyze it for trends and take a look at that patients medical history in the context of their genetic code. We do not have a lot of post-PGX data yet, because the study started in December, so I was only inputting pre-PGX data. Carol told me that next week I get to swab someone's mouth, so I am looking forward to that. It should be loads of fun.
Well, that was fun. I wrote my first blog post and did it on time! I will leave you with a gif. See you next week!
Woohoo! That's a pretty cool first week Jack! I love how you describe yourself as a sidekick!😂🎉 I think specialized medicine is so so cool! Do you happen to know what is so special about the 12 genes you guys are looking at?
ReplyDeleteI was thinking the same things, Lauren! Not your typical sidekick.. I was wondering, Jack, have you found or studied any trends in the way the genes of certain people react to medicine? Like does a certain gene react to a medication better for men than women? (Kind of a hard question to phrase so hopefully you understand) looking forward to next week's post!!
DeleteHey Lauren and Alexis! Both of you have excellent questions. To start with Lauren's, these 12 genes have been chosen because the presence or absence of them can have a large effect on the metabolism on a wide range of different drugs. So those genes are tested for, because they can determine the effects of drugs in different systems of the body (neurological, gastrointestinal, psychological, etc). To answer Alexis's question, I have not actually seen the results from the post study questionnaires yet, so I have not been able to see any sort of trends for the new medications that the patients are taking but I will definitely keep that in mind moving forward.
DeleteHi Jack! That seems like an interesting first week! Once you have more post-PGX data, will you be able to determine if this is a feasible method to personalize medicine for people? Or will there be a longer process? Also, do you know what software is used to analyze the data? I'm excited to read more! :)
ReplyDeleteHey Dhanya! After there is more post-PGX data, hopefully it will be more evident whether analyzing DNA is a feasible way to find the best drug. How they actually analyze the data is that, on a patient by patient basis, they look at the drug the person is taking and then looking at which of the 12 genes are present to see if the person is metabolizing the drug in an inefficient or harmful way. They do this because the presence of some of the genes may mean that the medication they are having problems with is not metabolizing normally in their body. Great question!
DeleteHi Jack! Sounds like you had a fun week. What is the significance of these 12 genes? How much time does the genomic testing take? Do you think this genomic testing could be used to create new treatments designed specifically for that patient later in the future, or just point them to alternative treatments that already exist? Have fun swabbing someone's mouth :))
ReplyDeleteHey Srishti! These 12 genes are chosen, because they all effect how substances are metabolized in the body and can have wide ranging effects (such as neurological, psychological, gastrointestinal, etc). I do not know how much time the testing takes but the patients receive the results within two weeks so I guess its pretty fast. Maybe genomic testing could help create new drugs but most likely it would just point to treatments that already exist, because you cant make a different drug for every individual person. And thanks I will swab the mouth real good!
DeleteSo I really just want to say that I love Jon Stewart. What exactly is the data you are inputting? Is it a record of the medication and dates started and whatnot, or is it more 0's and 1's?
ReplyDeleteHey Evan! The data being inputted are the surveys that the patient fills out during the first visit where they get the mouth swab. Keep up with the bomb questions!
DeleteExcellent first post. I am curious to know how effective the alternative treatments are after performing the gene tests. I can't wait to hear about your mouth swabbing experience.
ReplyDeleteHey Mr. Carey! I do not actually know how effective the alternative treatments are since I have not been able to see any post-PGX data yet but I will keep you updated!
DeleteThis is a very interesting post! I could clearly see the steps you will need to complete in order to complete your research. I am excited to see how genes will impact alternative treatments and enjoy swabbing that mouth.
ReplyDeleteHey Lindsey! Thanks! I got to swab during week 2 so you can read that post to see how it went!
DeleteHey Jack, sounds interesting! I'm really fascinated with your work individualizing treatments to cater to peoples' genes. Do you think you will have the opportunity to conduct a more hands-on approach in the future, perhaps analyzing the data with the patients in a one-on-one context? Thank you!
ReplyDeleteHey Dalton! It is hard for me to get a one-on-one opportunity with a patient, besides the mouth swab, because I am not a doctor, but hopefully I will get to have a bigger role in analyzing the data in the future.
DeleteKeep up the great work! I was wondering what kind of medical problems would these patients have?
ReplyDeleteHey Zak! The patients come in with all sorts of problems. Anything from psychological (like depression and anxiety) to skeletal/muscular (like lower back pain).
DeleteHi Jack! You might have no idea what I'm talking about but you know those commercials for some medicines where the list of potential side effects is longer than the part where they talk about the benefits of the medicine? Anyways, I feel like a lot of medicine that is necessary for people take have undesirable side effects that just cannot be helped. Do you only take complaints where people have unique side effects that don't effect most people or is it just anytime someone has a bad side effect?
ReplyDeleteHey Justin! I totally know what you are talking about! So, it is basically up to the patient whether they want the test or not. If they feel that want to try it and perhaps get a better drug out of it, then they come in and have the mouth swab. Also, most drugs have a lot of possible side-effects but that list is generalized for the entire population of people watching that commercial on TV so there is still the possibility that a patient will find a drug that works better for them.
DeleteHi jack! This is a great start to your project. The sense of humor is really good and the data seems organized. I was wondering what were common examples of people not being happy about their medication. Thanks for reading and I hope the best for your project!
ReplyDeleteHey Sam! Your question is actually really interesting, because as I was going through the data there were some drugs that kept popping up as not working. There is this one drug that is used for cholesterol called Crestor and it was giving many of the patients unbearable side-effects. Then also many people who suffered from chronic pain were having trouble with opioids (oxycontin, morphine, percocet, and vicodin). But the problems with the opioids is probably in part due to the fact that they are very addictive.
DeleteHey Jack! Sounds like you had a great start to your first week. I was wondering how it is possible to determine which medication is causing the patient problems if said patient takes multiple medications and if there was a way to analyze that or if the patient just needs to find alternative medications for each specific one. Thanks and can't wait to read more about your project!
ReplyDeleteHey Anisha! It may be hard to identify which drug is causing the patient trouble but when the patient remembers when they started taking the different drugs and when the problem began happening then it becomes much clearer. All of that information about past drugs used is included in the pre-PGX survey.
DeleteThis sounds interesting. Looking forward to learning more about this.
ReplyDeleteDr. Sahu
Thank you Dr. Sahu!
DeleteHi Jack, did you find that entering the data was exciting at all? And does this usually occur where a patient is unsatisfied with their medication? I can see how important entering all the data for surveys is for tracking the effectiveness of prescribing patients medication. I'm interesting to hear what's in store for next week.
ReplyDeleteHey Spencer! Entering the data was pretty boring I am not gonna lie, but it gave me more insight into the study as a whole. I think that a lot of patients are probably dissatisfied with their medications in general, but the side-effects definitely negatively impact some patients more than others.
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