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No wrong answers in this gene test

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There remains a stigma for people with mental health issues, one that seems to be more pronounced in Third World countries like the Philippines. Once a person has been labeled as suffering from mental problems, he or she is not considered fit enough to become a productive citizen and may likely be ostracized or made fun of.

Fortunately, this administration has emphasized the need to address it via the passage of the Mental Health Bill last year. As with all laws in the Philippines, everything needs guidelines for proper implementation. With the high cost of healthcare, mental illness needs to be given weight like any other disease afflicting many in our country.

Hit and miss

Genecept Assay, a product of Genomind that is a genetics company devoted to psychiatry, aims to reduce the “hit and miss” in the treatment process as it assists doctors in customizing treatment based on one’s genetic makeup.

“Probably, most of us are familiar with the traditional trial and error process in psychiatry,” says Dr. Lauren Few during the launch of the Genetic Assay recently at a hotel in Ortigas. Dr. Few has more than six years of clinical experience in the treatment of personality disorders, substance use and post traumatic stress disorder.

“A patient comes in with symptoms of depression, and that’s the preliminary diagnosis. I say preliminary because often we don’t know right away. So this is the best guess we have after maybe a 30-minute or an hour consultation with a clinician, and we just don’t have a lot of time to figure out what’s going on.”

Dr. Few adds that with this diagnosis, the trial and error kicks in. Prescribed medicines can show side effects like gastrointestinal problems or just “feeling weird.” Doctors would normally tell a patient that it takes time for medicine to take effect, and that would mean four weeks to a full month, and even sometimes six to eight weeks.

“So right off the bat, assuming you didn’t come to see your doctor the first day that you have symptoms, we’re talking about probably two months process to try out a medication that doesn’t work or that you are not tolerating well,” Dr. Few elaborates. “We substitute for a new drug and then we go through the same process.”

“So what we see in psychiatry are multiple treatment failures and you can imagine the toll that takes on the patient and the families, intolerable side effects, a lower quality of life and often medication compliance becomes an issue. If you’re taking medications that are causing all these extra symptoms, the likelihood of you continuing to take them as prescribed is not particularly high.”

DR. Lauren Few discussed how a genetic test like Genecept Assay can help optimize and personalize treatment for mental health conditions.

Right medications

With Genecept Assay, psychiatric doctors can prescribe the right medications with the right dosages based on their patients’ individual genetic makeup. For their part, patients would suffer less risk in terms of side effects, save on the cost of medication and most importantly, respond quickly and more favorably to the personalized treatment.

Genecept tests two types of genes: pharmacodynamic and pharmacokinetic.
Pharmacodynamic indicates the effect a drug has on the body, determines the selection of drugs that are safe, with low or no side effects and that are effective in relieving symptoms. Pharmacokinetic indicates the effect one’s body has on the drug determining the speed at which the body breaks down and gets rid of the drug.

“We don’t want you to think we can diagnose psychiatric disorders with genetics. We’re very far away from being able to do that. There are probably hundreds, if not thousands of genetic variants that contribute to risks for psychiatric disorders plus there’s a huge environmental component. So no one gene is going to be helpful as far as diagnosis and this type of testing is not going to tell you why you’re experiencing the symptoms that you’re experiencing.”

Dr. Few said the DNA specimen is collected through a very simple saliva swab. In the Philippines, the procedure is done by Global Medical Technologies. The registered medical technologists can do home service with the extraction at the patient’s residence or during a visit to the hospital.

“It’s not a blood test so it’s not invasive at all in that sense. It’s really quick and easy, about 30 seconds each side of the mouth and then it is sent to our laboratory in King of Prussia (in the Pennsylvania where Genomind laboratories are located).”

“The results are sent back to your clinician within seven to 10 days after the data collection. So it’s a really fast turnaround which, as you might imagine, is critically important in mental health. It’s important to us that the turnaround time is very rapid.”

Genes and environment

Genecept Assay can be used to guide treatment for a range of psychiatric conditions including the following: major depression, anxiety disorder, attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), bipolar disorder, post-traumatic stress disorder (PTSD), autism, schizophrenia, personality disorder, chronic pain and substance abuse.

“Genes and environment are important. It’s not nature or nurture but nature and nurture.
And that’s really important because we want to provide patients and families with reasonable expectations about genetic testing. It is not a hundred percent predictive of medication response. So we tell clinicians that it’s important to take all the pieces of information into account, the medical history and what other medications you may be taking as well as your genetics. So genetics is another piece of a puzzle.”

In a recent study, clinicians reported that 87 percent of their patients showed improvement with treatment guided by Genecept Assay. They also reported improvement in 91 percent of patients who had failed at least two medications in the past.

Dr. Few added that Genomind has tested over 200,000 thousand patients, mostly in the US, but has since expanded to about 23 countries worldwide. It has started offering the test in Southeast Asia and over 9,000 clinicians have ordered the Genecept Assay.

Gene test needed

She emphasized the immediate need for this testing method with the number of mental ailments worldwide.

”Data from World Health Organization states that over 322 million patients are living with depression and 264 million people are living with anxiety worldwide. So I’ve heard about the recent national mental health bill that’s been passed here and I think this data speaks about how important it is to start addressing this need in the population here.”

The Genecept Assay costs around P37,100, a price which might be considered prohibitive in the local market. But the fact that it reduces the “hit and miss” in treatment and wasted medicines would be enough reason to try it.

“It reduces treatment costs. And primarily, what drives that reduction treatment cost is that patients who have pharmacogenetic testing guided treatment have fewer emergency room visits and fewer in-patient hospitalizations. So those are things that tend to cost a lot of money. And so we see a reduction in treatment cost as a result of reduction in these visits,” Few explains.

Mitch Genato, CEO of Global Medical Technologies, says Genecept Assay has been available locally for the last three months. “We’ve already partnered with a couple of physicians, psychiatrists who already used this test. Our team will be going around and doing further medical detailing over all other institutions.”

Dr Few is hopeful that interest would increase once the test is covered by insurance.

”When we started testing in 2011 in the US, it wasn’t covered by any of the insurance companies. So it was all patient responsibility for payment. But once the demand for the test grew and patients started asking for it as part of the standard of care, we’ve seen that more and more insurance companies cover the test to varying degrees. And because we’ve generated some good cost-effective data, that has certainly helped insurance companies to feel more confident that paying for this type of test is going to reduce patient costs in the long term for them.”

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