Personalized, precise care

The ABCs of Biotech for Christians - Seventeenth in a series - P is for Pharmacogenetics

We hear about the Human Genome. Is there only one? Do all humans have the same one?

Clarification: The human genome is the complete set of nucleic acid sequences for humans, encoded as DNA within the 23 chromosome pairs in cell nuclei and in a small DNA molecule found within individual mitochondria. But each person’s genome is unique.

Pharmacogenomics, also called Pharmacogenetics, is the study of how genes affect a person’s response to drugs. “This relatively new field combines pharmacology (the science of drugs) and genomics (the study of genes and their functions) to develop effective, safe medications and doses that will be tailored to a person’s genetic makeup.” It is part of the field of precision medicine, which aims to treat each patient individually. (ref)

Because of the variation in human genomes, tailoring a drug to an individual can be an expensive project. However, progress in this special area of biotech is being made to lessen the individual expense. Identification of genetics variations that are associated with disease susceptibility and drug responses among individuals (“markers”)1 are being researched, and there have been some discoveries for specific therapies like warfarin, taken by many for blood coagulation.

Efforts to validate pharmacogenomics based algorithms for warfarin dosing have shown that such algorithms can improve the accuracy of dose prediction. However, converting theoretical benefit into validated clinical benefit has proven difficult… (ref)

This statement describes a difficulty with pharmacogenetics; it is hard to prove that the money spent on development is well spent, which brings us to a brief list of the challenges to the quest.

  • Evidence. There is not a weight of evidence that patient outcomes are significantly affected by individual therapies made possible through pharmacogenetics.
  • Reimbursement. The need for payment approved by insurance companies.
  • Integration into the electronic health record. (Not enough fields for the data, I guess.)

That last one seems funny but must be a real problem for those who have to make it all work. (ref)

A wonderful friend who sits near me at church, was recently diagnosed with pancreatic cancer. After trying some health supplements, he chose to have chemotherapy at one of the Cancer Centers of America that offers the pharmacogenomic approach to treatment. This hospital is not very near his home, but the doctor in his hometown was brutally negative in his prognosis, and it drove him and his wife away.

Hope is a critical element of any professional prognosis. Without it, there is no point in trying to get well. Any doctor can at least say, “Let’s all pray. God is still a God of miracles.” A true statement.

My friends experienced the warmest of receptions at CTCA and a hope for the future. Its website gives easy-to-understand explanations about the drug therapies given for pancreatic cancer (and other ones), so that a person can figure out what is going on when they get a treatment or take a pill. Some of these medicines are listed in the FDA’s table of biomarkers, showing that they have been studied for individual or groups with similar profile for genomic efficacy. (ref)

CTCA also advertises that they participate in clinical trials to offer patients innovative treatment options. The local doctor could have said that if a treatment were not to help, he knew of other avenues.

Back to the topic of Pharmacogenomics: the major criticism seems to be its cost to benefit ratio.

None of us can know if we will be faced with a decision to pursue an expensive route that could hold more promise than the one-size-fits-all offer. I am glad that my church has provided as much assistance as possible for our couple with this tremendous need.

It comes to my mind that individual support for human suffering and need is perfectly carried out by the body of Christ in the local church. The member whose intimate identity is known finds help in the arms of the Lord through his people. This is the most precisely perfect care that is possible to have.

1 The Food and Drug Administration (FDA) monitors drug safety in the United States. It now includes pharmacogenomic information on the labels of around 200 medications. https://www.fda.gov/Drugs/ScienceResearch/ucm572698.htm This information can help doctors tailor drug prescriptions for individual patients by providing guidance on dose, possible side effects, or differences in effectiveness for people with certain gene variants.

Help for addicts

The ABCs of Biotech for Christians - Sixteenth in a series - O is for Opiates

In the wizard of Oz, poppy fields nearly prevented Dorothy from reaching the Emerald City, but the good witch Glinda brought snow to cover its narcotic effects. What can bring the snow today to reverse the opioid epidemic? Biotechnicians are at work to discover the answer. And some nontechnical ways may help us as well.

First, let us consider that Oz was not where Dorothy and her companions found help for their ailments and dilemmas. She only had to believe that “There’s no place like home” before she could actually wake up and be happy to be home.

Likewise, for the individual seeking relief from addiction, whether from an illegal drug like heroin or from a legal one like oxycontin, there needs to be a belief, a firmly held conviction, that home is best. The vacation or escape from the base of ones true contentment must be viewed for what it is: flight.

Many people have no happy home, that is, they do not know Christ. No matter where they live, their home is not a comfortable place. Perhaps they have never known the love of parents, or maybe they suffer from fleshly pursuits, a Christian concept that recognizes man is a sinful creature who can only be free from destructive ways through daily walking with the Lord, empowered by His Spirit.

Pain is not the worst enemy in the world. The lack of having a friend with us, Jesus, to endure whatever comes is far, far worse.

It is good to make use of medicines to manage pain, or to have a brief vacation from the press of responsibilities and concerns, but should we pursue means that take over our will, then we will swoon in that poppy field until deliverance comes.

Perhaps that deliverance will come from a supernatural intervention, nevertheless, without an understanding that one needs to be home, that is, in right relation with the Father, there will be other escapades or misguided journeys to discover what is missing.

Addiction, as an obstacle, is the false promise of relief, whether from physical or emotional pain or discomfort. Indulgence in pain relief (on the scale of addiction) is pursuit of a short-term solution, but the addict must first of all start to think LONG-TERM. Long-term is what matters. For what will it profit a man if he gains the whole world and forfeits his soul? Or what shall a man give in return for his soul? (Mat 16:26) And without a doubt, what we are talking about as we address the topic of opiates, is the war for the soul.

Let's think now about solutions for opioid addiction and biotech. As you would imagine, biotech is researching the DNA of the poppy, but maybe it would surprise you to know that the reason for this, in one study, was to determine what area of the world the opium came from. In this way, law enforcement can focus their efforts efficiently. “Source information may provide valuable intelligence leading to the interruption of this terror-funding stream or other illegal activities.”

Biotech is also involved in manufacturing drugs that are not possible for laypeople to replicate. Researchers in Japan have tweaked the genes of the E-coli bacteria to pump out a substance that can be modified to make painkillers. "Four strains of genetically modified E. coli are necessary to turn sugar into thebaine... E. coli are more difficult to manage and require expertise in handling. This should serve as a deterrent to unregulated production."

Discovering that clearing out old cells, “senescent” cells, helps to prevent joint degradation and promote renewal in mouse joints, can lead to medicines that will do this for humans. Pain relief for those with osteoarthritis is in the works.

There is also work toward relieving post-surgery pain with a drug that would be an alternative to addictive opioids, a sustained-delivery formulation of buivacaine. This new drug “combines aspects of biology, medicinal chemistry and polymer science to allow for the precise engineering of drug particles in various compositions, sizes and shapes” and would provide “an effect consistent with a local anesthetic effect lasting for three or more days.”

While waiting for these new drugs to reach the marketplace, there are also natural means of help for addicts and those with chronic pain.

Scientists have studied the effects of Persian Carum Coptic fruit and Rose of Damascus essential oil on morphine withdrawal in mice and found that their biological effects are useful for this process.

Dark chocolate helps the heart via opioid receptor activation. Natural highs gained through some foods and through exercise are safe to enjoy, in moderation.

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...and every living creature that moveth, which the waters brought forth abundantly, after their kind, and every winged fowl after his kind ... the living creature after his kind, cattle, and creeping thing, and beast of the earth after his kind ...the beast of the earth after his kind, and cattle after their kind, and every thing that creepeth upon the earth after his kind: and God saw that it was good. -Genesis 1

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Flesh and Bone and The Protestant Conscience is an e-book on Amazon.com. It is 99¢ and in the Amazon lending library as well. It is also available here in PDF format. The book description follows.

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