TAG of the Week:
With new technology comes the high cost of using it. If you were a physician treating an HIV positive patient, would you use it and what are your reasons? What factors would hinder you from using the new technology? Dr. Barlow mentions that new physicians seem to be hesitant about using this new technology but in Taiwan (http://www.genomeweb.com/making-case-cost-effectiveness-pharmacogenetic-testing-taiwan) there seems to be a cost-effective reason to implement and incorporate pharmacogenomic testing for HIV patients. Can you suggest possible barriers in the US health care system or other factors that can be involved with the hesitance?
http://formularyjournal.modernmedicine.com/formulary/Pharmacoeconomics/Gene-testing-stakes-a-claim-in-the-health-benefits/ArticleStandard/Article/detail/679086
If I were a physician treating an HIV positive patient, I would use the new technology of pharmacogenomic testing. First off, the testing is usually very simple--all it could require is a cheek swab to obtain the DNA, which is much more effective than blood collection, for instance. Not only that, but as Barlow’s article indicates, genomic tests can show if a patient will benefit from the use of particular drugs. In a personalized approach, doctors can alter the dosage of a drug as it pertains to each patient’s genome. Therefore, the safety and effectiveness of the drug, as well as the patient’s response to it, will be enhanced because the medical care is unique to the patient. By studying the patient’s genetic predispositions, the doctor can prescribe the medication that really is best for that one person, as opposed to what studies and trials claim is best for the general population. There are also financial benefits to this new technology—decreased hospitalizations (possibly due to contraindications) and decrease in drug spending (since patients waste money on prescriptions that can clash with their genetic backgrounds). I believe that Warfarin, the frequently prescribed blood-thinner, provides good evidence as to why pharmacogenomics should be utilized more frequently. Warfarin is difficult to prescribe because patients respond differently depending on their genetic makeup. As a result, the FDA recommended that all patients should obtain genetic testing prior to using the drug because adverse events, including death, could occur. I think this recommendation can be applied to an array of drugs, ranging from Warfarin to HIV, because genetic variations influence drug response tremendously.
ReplyDeleteI agree with T. If the technology for pharmacogenomic testing is improving, there is no reason why physicians should hold back from providing these tests to patients and then prescribing medication accordingly. Since pharmacogenomic testing, according to the article, is becoming a more legitimate process than disease predisposition testing, physicians should even encourage it if it can improve the chances of successful treatment, in comparison with predisposition tests advertised DTC, which can jeopardize health. Furthermore, if the long-run predicts savings for health plan providers, it could be a win-win situation for buyers as well as companies. Also, if these tests become more popular, the price for genome testing could be driven down, increasing the odds of less wealthy people to also benefit from the technology. Surely, there are negative sides to this issue, but at this point, support for the developing technology seems more beneficial than hazardous and should be promoted so that it can become even more advanced.
ReplyDeleteIf I were a physician treating an HIV positive patient, I would definitely use the new pharmacogenomic testing technology because doing so would create more options and broaden the possibility for improvement. I would initally be wary of the safety and effectiveness of using such new technologies but, as the second article states, pharmacogenomic tests have been validated by peer-reviewed research, and their worth in improving drug safety and efficacy is now reflected in many drug labels. Medical innovations pave the way for new discoveries and also aid in further improving the development of technology for the future. If we are consistently using the old and current technology, with its known inadequacies, there will be no movement towards the improvement of public health. Although new technology may come at a high cost, it is a good investment for lowering costs in the future through more effective prevention and treatment. Pharmacogenomics is greatly contributing to more personalized medicine, as the use of genetic testing for predicting responses to drug therapy is helping physicians to prescribe different medicines according to each individual's condition. By analyzing patients' genes and their predicted responses to drugs, physicians are able to help each patient based on their specific needs. And by prescribing new specialized medicines that are determined to be more effective than the generic, the chance to prevent and improve conditions increases. By preventing diseases by early intervention and treating diseases more effectively, we are able to save costs in the future and also improve health of the overall population. The fact that the United States health care delivery system is so fragmented and scattered, structurally and financially, may pose as a barrier to the implementation of pharmacogenomic testing.
ReplyDeleteI agree with the previous posters that this pharmacogenomic testing has the potential to improve treatment of HIV using maraviroc. HIV is already a complicated virus that increases susceptibility to a multitude of other infections. As a doctor I would welcome a gene test that would indicate whether a patient's HIV type is susceptible to the drug or whether treatment with maraviroc would be futile and in essence harmful to the patient.
ReplyDeleteHowever, there are many barriers in the U.S. that are currently preventing pharmacogenomic testing from becoming more mainstream. As the article mentioned, younger doctors tend to be more hesitant in using pharmacogenomic testing. This is not surprising given their lack of experience and confidence compared to the older generation of physicians who are more likely to personalize care for each patient since the basic clinical skills are second nature to them. I also believe that more insurance plans will have to cover this type of testing in order for it to become more available to the public. A patient may deny (or be denied) this type of testing even if it is potentially lifesaving, if they cannot afford it.
I also agree that as a physician I would use the pharmacogenomic test to treat a patient with HIV. When weighing the costs and benefits of testing a person before prescribing a drug that may have adverse affects depending on the person taking it, I think it is an obvious choice to utilize the test. The tests overall seem like they are cheaper to administer than to not and have to pay the health costs for the consequences of a bad reaction to a certain prescription medicine. Also I feel like by not using the test precious time is being wasted seeing if the drug is going to be effective. Instead, if the HIV patient took the test and found out that they would have complications from taking that type of drug the doctor could instead initially prescribe something else saving the patient time and injury. I think that if this test is available it is almost the doctor's moral responsibility to test them for it because otherwise they could be causing the patient harm. The only thing that would hinder me from using the technology would be if it was really invasive and the patient would decline the procedure or if it was not a proven and reliable test. I think that this test is so widely accepted in Taiwan because it is cost effective and their population is much more homogeneous then the United States. In the U.S. the population demographics vary greatly by area and could hinder the effectiveness and reliability of genetic tests. Another reason why physicians might be hesitant of ordering a test is because insurance companies might not pay for it at this point in time. I also think that physicians are slow to adopt these tests because in order to trust the results when dealing with a patient's life and how they will react to a drug they might trust their judgment over a test that they do not believe has been studied and proven to be successful enough in the early stages.
ReplyDeleteAs a physician, I would use any and all new technology available, once I have done extensive research about a specific drug or screening procedure. I think educating myself, reading articles from both sides of the spectrum, will allow me to follow understand the drug or procedure and further use my knowledge to make a decision if I want to go further and talk with my patient about the possible choices available. As Barlow states, those doctors who are better informed about pharmacogenomics tests are twice as confident to order tests—doubt and insecurity of information may turn doctors, especially those recently out of medical school, away from prescribing patients those tests. Also doctors should inform their patients as well—tests generally require only taking a check swab or a saliva collection to obtain a DNA sample; blood does not need to be drawn.
ReplyDeleteNew technology also provides us with new information about diseases, their reactions, good and bad, etc. For example, the article discuss the human immunodeficiency virus (HIV)—before receiving the antiretroviral drug abacavir, one should be tested for a specific gene (HLA B*5701) in order to identify the “risk of a possible hypersensitivity reaction to the drug, which can cause serious and sometimes fatal complications” (Barlow, 2010). At the time when it was discovered to perform this ‘extra’ test, physicians could have doubted the expense at which to perform the test, but with enough education and research, those would see it is imperative to have these patients screened before prescribing abacavir or maraviroc (another similar drug).
As previously mentioned education is very important; one must keep themselves informed. If doctors, not very likely, and patients are uninformed about new technological advances in medicine, this will limit and eventually halt the usage of new medication protocols. Another clear barrier of entry is cost—the cost of the drug, the doctor visit, other personal involvement, etc. Those who may need new technology advances may not be able to afford it, therefore ‘wasting away technology’ and the use of a drug or machine. For example, a machine may cost an office $100,000, but if only 50 people (at a rate of $500 per screening) use the machine, the office is not making a profit—that is why screening isn’t this ‘cheap’ and or prices will increase to an amount that is ‘worth’ having bought the machine.
If I were a physician treating an HIV positive patient, I would definitely use the new technology of pharmacogenomic testing to better treat my patient. This new technology seems easy, reliable, and cost-efficient. It would be good to target treatment based on a person’s genetic make-up. As T. Contreras mentioned this new technology has the potential to reduce hospitalizations and drug expenditure. Maybe even reduce death rate for some diseases. Even though, this new technology seems ideal we are once again focusing only on the genetic make-up. It is important to take the patient’s environment into account as well. Pharmacogenomic testing can be safer and more effective than our current technology, but it is not a 100% accurate. The environment (stress, lifestyle, eating habits, smoke, alcohol, drugs, living conditions, etc) can have a negative impact on the patient’s treatment. This technology would be good to use but as a physician I wouldn’t solely based the treatment on genetics.
ReplyDeleteOne of the possible barriers would be insurance companies who might not want to cover the costs. Also pharmaceutical companies could do whatever they want with the cost of medicine.
As a physician, my main concern would be the patient's general well-being. The advancements in pharmacogenomics present a new approach to prevention of medical errors and premature deaths. When patients go to physicians, they expect to get better or at least to receive help managing an illness. They are not expecting to receive treatment that is ineffective for them or may even do more harm than help, such as the adverse reactions that can occur from the drug Carbemazepine. This is why I would use pharmacogenomic testing to improve the treatment I give my patients.
ReplyDeleteStill, cost is another important consideration in health care. In this case, pharmacogenomics has the potential to avoid spending money on serious medication-related complications. It also has the potential to avoid waste by initially guiding the physician away from less effective treatment options and towards more favorable treatments based on patients' personal genetic makeups. However, cost could be a huge barrier to the implementation of pharmacogenomic testing as a regular practice in the United States. For example, patients with HIV who are without insurance would be less likely to receive this testing. Despite the added benefits to the patient and the potential to save money, pharmacogenomic testing may not even be offered to this subset of the population. To some physicians it may be seen as an extra measure, rather than a necessity in the treatment of their patients.
As a physician, I would use any and all new technology available, once I have done extensive research about a specific drug or screening procedure. I think educating myself, reading articles from both sides of the spectrum, will allow me to follow understand the drug or procedure and further use my knowledge to make a decision if I want to go further and talk with my patient about the possible choices available. As Barlow states, those doctors who are better informed about pharmacogenomics tests are twice as confident to order tests—doubt and insecurity of information may turn doctors, especially those recently out of medical school, away from prescribing patients those tests. Also doctors should inform their patients as well—tests generally require only taking a check swab or a saliva collection to obtain a DNA sample; blood does not need to be drawn.
ReplyDeleteNew technology also provides us with new information about diseases, their reactions, good and bad, etc. For example, the article discuss the human immunodeficiency virus (HIV)—before receiving the antiretroviral drug abacavir, one should be tested for a specific gene (HLA B*5701) in order to identify the “risk of a possible hypersensitivity reaction to the drug, which can cause serious and sometimes fatal complications” (Barlow, 2010). At the time when it was discovered to perform this ‘extra’ test, physicians could have doubted the expense at which to perform the test, but with enough education and research, those would see it is imperative to have these patients screened before prescribing abacavir or maraviroc (another similar drug).
As previously mentioned education is very important; one must keep themselves informed. If doctors, not very likely, and patients are uninformed about new technological advances in medicine, this will limit and eventually halt the usage of new medication protocols. Another clear barrier of entry is cost—the cost of the drug, the doctor visit, other personal involvement, etc. Those who may need new technology advances may not be able to afford it, therefore ‘wasting away technology’ and the use of a drug or machine. For example, a machine may cost an office $100,000, but if only 50 people (at a rate of $500 per screening) use the machine, the office is not making a profit—that is why screening isn’t this ‘cheap’ and or prices will increase to an amount that is ‘worth’ having bought the machine.
I agree with the posts above that if I were a physician treating an HIV positive patient I would use the new technology because as a physician, my primary job is to take care of my patient to the best of my abilities, which including providing the best treatment possible. This assumption is under the fact that the new technology has been shown to be effective and can actually help my patient. The measures necessary to obtain samples is minimally invasive and the information gathered would enlighten me not only about my patient’s risks of that particular disease but also about the predisposition to other diseases as well. Factors that would hinder my use of the new technology would be the funding that I receive from the hospital or clinic that I work at as well as the acceptance of my patients’ to use the technology. If I purchase the new technology and no one wants to use it, I stand to lose a great deal of money. Patients may be more willing with the help of the insurance industry, which may be advocated to help pay for the high cost of the new technology. Other barriers of entry may be the environmental factors that a patient encounters and old doctors who may want to stick to their methods instead of adopting the new technology.
ReplyDeleteI would definitely use this type of testing for HIV patients to discover what type of drug they would need to use. The person would have to supply a cheek swab which is even easier than obtaining a blood sample. Also this is a major example of personalized medicine which could be benefit everyone. This system would be able to better match people to certain drug treatments that are associated with their type of HIV and their genes. This could be much more effective and a safer way to prescribe drugs to people. I believe this system could be a bit controversial in the United States. We have a huge issue with privacy especially when it comes to gene therapy. I believe this would a gradual implication that would need to be completely voluntary and consent of the patient would have to be enforced. The ethical and privacy issues that could ensue because of this could ultimately end the treatment program. I do believe this would extremely beneficial for all people and it is a simple way to advance personalized medicine. Also I believe a physician has the responsibility to treat patients with the most efficient and effective care possible and it seems in terms of HIV this method would be it. I would expect my physician to present me with the most up to date and effective treatment possible. I think implementing this could be difficult at first but in the end it would be efficient and effective.
ReplyDeleteI would definitely use this technology on my patients if I was a physician. I believe this technology could enhance the idea of personal medicine. I believe this technology could be the most efficient and effective way to treat HIV. This process is far less invasive than an STI test or a blood test. Being able to take a cheek swab is extremely simple and is something that everyone can do. This could completely change the face of personalized medicine. I believe as a physician it is extremely important to offer the most advanced and proven successful methods of treatment should be offered to all patients. I believe this treatment could be difficult to implement in the United States because of privacy. In the US there are often issue with things like privacy and consent and I believe that would be an issue in implementing this program. There would need to be strict, rigorous rules to be able to gradually introduce this program. I believe this type of treatment needs to be completely voluntary and with the consent of the patient. Because of gene testing and genetic knowledge of an individual the treatment can be better matched to the individual, the best path of treatment could immediately given to the patient. I believe this could reduce error of treatment and could lengthen the life of the person with HIV
ReplyDeleteI also agree with the posts above. If I was a physician treating an HIV positive patient I would definitely use the new technology. As a doctor my responsibility is to help the patient in any possible way that I can. As explained in the article, the ways of obtaining the DNA samples are minimally invasive. It seems like common sense to test a person before prescribing a drug that may have adverse affects. The testing would aid in the health of the patient. Pharmacogeniomc testing would improve the treatment that I give to my patients. I would not want to end up doing more harm then help.
ReplyDeleteThings that would hinder me using the new technology would first be the support of my work. The hospital may think the testing is too risky or too expensive. My patients may also be skeptical to this new technology and may not use it which would then end up being a waste of money. I agree that patients may be more willing to use the technology if it was advocated by insurance companies who helped pay for it.
In the article, “Gene Testing Stakes a Claim in the Health Benefits Marketplace” Barlow demonstrates the efficiency of genetic testing and its ability to demonstrate if a patient will benefit from the use of particular drugs. This would allow for an aggressive approach in treating the disease because the physician will be able to treat more effectively treat their patients due to the ability to alter drug dosage or drug type as it pertains to each individual’s genome. By understanding each patient’s genetic predispositions, can more readily prescribe medication that will be the best and most efficient for each individual patient, rather than basing what course of medication the patient will take on the results of research studies and trials. Therefore, if I were a physician and were treating HIV positive patients, I would use the new technologies and genetic testing to cater to each individual patient, because the success of a drug, in addition to patient response, will be enhanced due to the individualized nature of their medical care. In addition to the patient benefit of using the new pharmogenomic testing, there would also be financial benefits that can arise from such new technologies. This would be due to the decrease in drug spending and fewer hospitalizations, because each patient will be placed on medication that is most efficient for them and will thus, experience better outcomes, decreased mortality and morbidity.
ReplyDeleteI agree with a number of the posts above. Technology is continually improving and I believe in order to see the results from such technology, doctors must be willing to offer and recommend its use to their patients. Thus, I would definitely recommend its use to my patients, if I was a physician.
ReplyDeleteAs a physician, my main concern is my patient's well-being. Thus, it is my responsibility to make my patient aware of the treatments available for his/her diagnosis. I think if a doctor does not offer new technology to his patients, he is withholding treatment that could improve his patient's life. Additionally, I think it is important that a patient recognizes all the treatments available, so that he could make the best decision that will improve his health outcome.
Additionally, I would recommend the use of technology because through the use of pharmacogenomics, health is gradually improving - whether it be because of less medical errors or improving treatments. Thus, it is important to take into account the new technologies that are arriving and access whether the treatment could be more beneficial - to the person and society as a whole.
However, I understand that a doctor may choose not to utilize technology due to its 'newness.' I feel that many doctors currently find technology to be risky as it has not be used enough to see long term outcomes. Additionally, due to the fact that new advances in technology are so new, they are also very expensive. This could be an issue as insurance companies may not want to add technological treatments into their plans and patients may not be able to afford the treatment without assistance from insurance.
If I were a physician, I would not hesitate to implement pharmacogenomic testing into standard care for all patients. Many studies have confirmed that gene or biomarker tests for antiretrorival drugs such as abacavair allows the physician to identify those HIV positive patients at risk for a hypersensitivity reaction to the drug. Through introducing this new cost effective technology, the physician minimizes the risk of serious or fatal complications, thereby improving the safety and efficacy of the drug. As mentioned in the article pharmacogenomic science is still in its early stages causing much uncertainty within the medical community. However as new studies emerge and the cost of genetic testing decreases 10-fold each year, it will not take long before we can see the improvements caused by genetic testing.
ReplyDeleteThe article indicates that well-informed doctors are twice as likely to order these tests for their patients. Consequently, the first barrier to be altered is clinical education. As physicians gain knowledge on the success of each test they will be encouraged to adopt the method for clinical use. Some can be administered by taking a cheek swab or saliva collection, this simplicity reduces the burden on the patient while delivering effective personalized care. Once physicians begin to use genetic test as standard care, we can eliminate another barrier posed by insurance companies to cover each test.
If I were a physician, I would not hesitate to implement pharmacogenomic testing into standard care for all patients. Many studies have confirmed that gene or biomarker tests for antiretrorival drugs such as abacavair allows the physician to identify those HIV positive patients at risk for a hypersensitivity reaction to the drug. Through introducing this new cost effective technology, the physician minimizes the risk of serious or fatal complications, thereby improving the safety and efficacy of the drug. As mentioned in the article pharmacogenomic science is still in its early stages causing much uncertainty within the medical community. However as new studies emerge and the cost of genetic testing decreases 10-fold each year, it will not take long before we can see the improvements caused by genetic testing. The article indicates that well-informed doctors are twice as likely to order these tests for their patients. Consequently, the first barrier to be altered is clinical education. As physicians gain knowledge on the success of each test they will be encouraged to adopt the method for clinical use. Some can be administered by taking a cheek swab or saliva collection, this simplicity reduces the burden on the patient while delivering effective personalized care. Once physicians begin to use genetic test as standard care, we can eliminate another barrier posed by insurance companies to cover each test.
ReplyDeleteIf I were a physician, I would not hesitate to implement pharmacogenomic testing into standard care for all patients. Many studies have confirmed that gene or biomarker tests for antiretrorival drugs such as abacavair allows the physician to identify those HIV positive patients at risk for a hypersensitivity reaction to the drug. Through introducing this new cost effective technology, the physician minimizes the risk of serious or fatal complications, thereby improving the safety and efficacy of the drug. As mentioned in the article pharmacogenomic science is still in its early stages causing much uncertainty within the medical community. However as new studies emerge and the cost of genetic testing decreases 10-fold each year, it will not take long before we can see the improvements caused by genetic testing. The article indicates that well-informed doctors are twice as likely to order these tests for their patients. Consequently, the first barrier to be altered is clinical education. As physicians gain knowledge on the success of each test they will be encouraged to adopt the method for clinical use. Some can be administered by taking a cheek swab or saliva collection, this simplicity reduces the burden on the patient while delivering effective personalized care. Once physicians begin to use genetic test as standard care, we can eliminate another barrier posed by insurance companies to cover each test.
ReplyDeleteIf I were a physician, I would not hesitate to implement pharmacogenomic testing into standard care for all patients. Many studies have confirmed that gene or biomarker tests for antiretrorival drugs such as abacavair allows the physician to identify those HIV positive patients at risk for a hypersensitivity reaction to the drug. Through introducing this new cost effective technology, the physician minimizes the risk of serious or fatal complications, thereby improving the safety and efficacy of the drug. As mentioned in the article pharmacogenomic science is still in its early stages causing much uncertainty within the medical community. However as new studies emerge and the cost of genetic testing decreases 10-fold each year, it will not take long before we can see the improvements caused by genetic testing. The article indicates that well-informed doctors are twice as likely to order these tests for their patients. Consequently, the first barrier to be altered is clinical education. As physicians gain knowledge on the success of each test they will be encouraged to adopt the method for clinical use. Some can be administered by taking a cheek swab or saliva collection, this simplicity reduces the burden on the patient while delivering effective personalized care. Once physicians begin to use genetic test as standard care, we can eliminate another barrier posed by insurance companies to cover each test.
ReplyDeleteIf I were a physician, I would not hesitate to implement pharmacogenomic testing into standard care for all patients. Many studies have confirmed that gene or biomarker tests for antiretrorival drugs such as abacavair allows the physician to identify those HIV positive patients at risk for a hypersensitivity reaction to the drug. Through introducing this new cost effective technology, the physician minimizes the risk of serious or fatal complications, thereby improving the safety and efficacy of the drug. As mentioned in the article pharmacogenomic science is still in its early stages causing much uncertainty within the medical community. However as new studies emerge and the cost of genetic testing decreases 10-fold each year, it will not take long before we can see the improvements caused by genetic testing. The article indicates that well-informed doctors are twice as likely to order these tests for their patients. Consequently, the first barrier to be altered is clinical education. As physicians gain knowledge on the success of each test they will be encouraged to adopt the method for clinical use. Some can be administered by taking a cheek swab or saliva collection, this simplicity reduces the burden on the patient while delivering effective personalized care. Once physicians begin to use genetic test as standard care, we can eliminate another barrier posed by insurance companies to cover each test.
ReplyDeleteAlthough I do agree with the previous posters who said they would use the treatment, I want to play the devil’s advocate and say no I would not use the new technology due to the high cost of using it. This is largely because I question where the funding for these drug treatments are going to come from? According to the laws of payment and reimbursement of the American health care system the money needs to come from some place and since the population where HIV is most prevalent is among individuals of lower economic standing the money would have to come from an increase in taxes of those who are more privileged yet still have a difficult time affording these treatments. In addition as a physician I might be at a road block between being able to provide this treatment to HIV + patients and being able to treat other patients with other diseases and injuries who can afford the cost of treatment for their ailments. Thus by not implementing this new technology as soon as it came out I would wait until the laws of supply and demand economics set in; when the supply of these HIV treatments is minimal I would not order the treatment for my patients because there would be a high cost for its use, thus I would wait until the cycle of new drugs came out before I started using the older drug because it is an older version and the cost would not be as high because the demand for this drug would not be as high as the new innovative technology so according to the laws of supply and demand, the firms providing these drug technologies would reduce their prices in order for their products to sell. This is just a thought and an attempt to think outside of the box, and by no means is intended to offend anyone.
ReplyDeleteIn attempts to post an original comment to this blog, I want to consider the specific reasons why pharmacogenetics would be especially useful in the treatment of HIV. In relation to our class on Tuesday on drug resistance, this is becoming an increasing problem in the treatment of HIV, especially in Africa. If genetic testing was used in these cases, doctors would already know when treatments would never be effective for their patients; therefore, saving money and time for both patients and doctors. Although it was mentioned that genetic testing could lead to the discovery of other disease; however, it is more cost-effective to treat a disease in the earlier stages than the complications associated with a later-term illness.
ReplyDeleteOverall, I think with the pro-comprehensive medicine that Americans are accustom to, they would be in favor of phramacogenetics. Additionally, from a federal perspective, there is a huge potential for cutting overall healthcare costs. Finally, I think that in reality, in contrast to the article, many American doctors always want to be on the cutting-edge of medical procedures.
I think that everyone is making really good points about how pharmacogenetics could reduce costs and lead to more efficient treatment of HIV-positive patients. The use of such technologies in Taiwan should be an inspiration to U.S. physicians, particularly because it seems to be effective on various levels. Having said that, U.S. physicians still have yet to jump on the band wagon. There are a few key explanations behind this underuse of a valuable new technology in the treatment of HIV in this country. Most importantly, lack of standardized and consistent education of health care professionals about not only the value of pharmacogenetics but also the mechanisms behind it and how to use it properly in a clinical setting is a major barrier. If physicians were taught the value of this new technology, they would be more inclined to use it in the treatment regimen of their patients. Furthermore, if they were taught how to use the new technology properly, they would be more confident in their skills and would be more inclined to use them in this sense as well.
ReplyDeleteThe inconsistency of educational efforts and the teaching of new clinical skills using new technologies is a major pitfall of our health care system. In Taiwan, it seems that health care professionals and public health officials are intent on using the latest, most efficient technologies, and as a result have introduced them into the health care system effectively. In the U.S., however, our efforts are not so standardized and direct, which results in different skill sets, clinical techniques, and levels of knowledge being used in the treatment of patients. If we were to standardize these aspects of health care and keep physicians up to date on the most effective technologies (such as pharmacogenetics), then patients would be treated in the most consistent, efficient manner possible.
If I were a physician treating a patient with HIV I would most definitely use pharmacogenomic testing. It seems as if the testing is not only accurate, but also easy to use. If there is a slight risk of complications, including some which may be fatal, it is imperative to identify a patients risk for a hypersensitive reaction to the drug. Having personal experience with the drug Warfarin, I know how important it is to monitor the dosage of the drug. When I was a patient using this drug, I had to have my protime/INR levels checked weekly to ensure that I was receiving the proper dosage. The reported rate of a 30% drop in hospitalization rates for patients who received gene tests as part of warfarin therapy initiation, is an astounding number. If the same result can be achieved with genetic tests for HIV medications, the number of deaths and complications from these medications can be reduced, while increasing the effectiveness of the drug. It is important that clinicians are educated on the importance of genetic tests, as well as when and how they can be used effectively.
ReplyDeleteIf I were a physician, I would notify my patient about the possible pros and cons of using or not using new technologies that test for genetic markers that may be beneficial to their taking of antiretroviral medication. However, I would emphasize the importance of taking these genetic tests.
ReplyDeleteLooking at genetic testing in regards to pharmaceuticals in a utilitarian point of view, it makes the most sense to test patients for their genetic disposition to certain drugs, in this case antiretroviral drugs. Not only would it benefit the patient, but it can create a cascading effect, leading to less individuals and their health being adversely affected by medication. As both articles mentioned, genetic testing can yield great results that can save lives, prevent future illnesses, and hinder enormous monetary damages in the long run. These tests can also help cut overall healthcare costs, which can help alleviate some of the disconcerting views of politicians and policy makers.
The only way for insurers, such as Medicare and Medicaid, to step up and increase reimbursement for genetic testing is through studies that provide data that show significant benefits of genetic testing. Genomics and pharmagenomics are evolving fields that need more awareness of physicians and the general public.
If I were a physician dealing with an HIV positive patient, i would surely be in support of the usage of pharmacogenomic testing due to its accuracy rates and its simplicity. The ability to find a patients inability to take certain medications is such an improvement and when i visited the Aid Atlanta headquarters in Atlanta, GA a few weeks ago, one fact that stood out to me is that the reason why many patients die from teh diease is their inability to take the meds that will cure then due to allergic reactions along with the inability to find a replacment in time. The proper dosage is also important to monitor because an over dose or under usage can be a factor in the recovery of the patient. If the amount and be determined through ones genetics, I would definitly use this tool.
ReplyDeleteI personally believe that doctors should use this new advancement to treat HIV patients even though there is a high cost. With the information given by this test we can get some questions answered and better treat the patient, this is why the high cost should not matter because it is worth giving someone good quality of life.
ReplyDeleteIf you think about it you could give a certain drug to someone with HIV and they might not respond well, thats a treatment gone to waste and money gone to waste so physicians might as well do the test first and that will be money well spent. I do not think that a problem of cost should be the reason why someone doesnt get the medical care they deserve and as explained in the article maybe there will eventually be cheaper ways of doing this.
Barriers for using this in the US today I think are a few but the biggest one would definitely be the never-ending problem of insurances. Obviously this is a costly test and a lot of people do not have money to pay for it all themselves but I think insurance companies should do their job and help people with this since HIV is a disease affecting many people around the world. Second, as mentioned above another barriers might be getting this idea into the "market" getting doctors used to this and willing to use this new idea.
I think the comparison between the US and Taiwan makes a good point about how the different health care systems can affect the use of these new technologies. With a universal reimbursement system I think it becomes easier to manage the widespread distribution of new technologies, and can be done in a more cost-efficient way as in Taiwan. I agree with Olga L. that in the US, there are many different reimbursements systems and issues with insurance coverage that could potentially leave some people unable to receive testing or at a greater disadvantage than others, making the US a more difficult place to implement something new and have it be successful and widespread.
ReplyDeleteI agree that pharmacogenetic testing is a good idea for improving effectiveness of drugs and would be especially helpful for a disease like HIV with many components and a need for a way to specify individual care. With the use of this technology however, I think the US would need to think about the distribution of testing and reimbursement systems that could provide equal access. T. Burks mentioned issues like burdens for taxpayers and high costs, but I think it could save a lot of money in the long run (not to mention people's lives) and would not present any major short-term burdens that wouldn't be made up for in time. I also think supply and demand economic principles are not the best way to think about costs of health care, a very unique market with different cost-control principles.To make this work in the US, I think the testing would need to be assessed for maximum cost-efficiency and marketed for the conditions it would work best for, and that all insurance companies should be made to reimburse this testing.
I also agree with the rest of my colleagues and I would use these genetic tests to treat an HIV positive patient. It has been concluded that there have been great benefits to using these tests to help treating these patients by having a better understanding of what medications to use. The job of a physician is to work with their patients and to do anything possible that would help treat and prevent conditions from getting worse for their patients. By withholding tests or treatments that have been shown to be effective to helping patients, I believe that the physician is not performing their job to the best of their ability. Even though these tests can be costly, which is why there has been hesitation in the US to use these tests, it has been shown that it has in fact helped reduce hospital and other healthcare costs. The problem with making this work in the US is that many insurance companies would not want to pay for these tests and many people would not want to pay the extra costs for their insurance to cover for these tests as well. I believe that if people realize the cost-effective benefits of taking these tests and utilizing them more in the US, people will begin to realize the great benefits that they will bring to the healthcare system and the manner in which we treat disease.
ReplyDeleteIf I were a physician treating an HIV positive patient, I would use pharmacogenomic testing. If we have the technology to use genetics to tailor a drug treatment that is going to work best for the patient, then this should be utilized. The patient is benefiting from knowing that the particular drugs they are receiving are going to really work in relation to their genetics. The factors that could hinder me from using this new technology is that the FDA may have some issues with this technology and also the individuals patients may not believe that pharmacogenomics is the best option for them because they may not be educated enough on the topic. However, I believe that pharmacogenomics is an expanding field and will really help benefit an enormous amount of the population. The ability to personalize a medication plan based on genetics is unbelievable.
ReplyDeleteIf I was a physician and a patient came to me who was HIV positive, I would use pharmacogenomic testing to determine how he/she should be treated. The new information that we are able to obtain through this testing is unparalleled. In the past, physicians have had to focus solely on experience when prescribing a drug. I am sure that many noticed the harmful side-effects that a particular drug had on a select group of patients, but without being able to pinpoint the problem there was no way of predicting who would react badly. With pharmacogenomic testing, doctors can foretell how a patient will react to a drug and even if their body will respond to the drug.
ReplyDeleteMaking medicine personalized is important in developing new treatments. Instead of trying one medicine after the other, using this technology we can see what medication will work on the patient before having to “experiment.” In the end, this could prevent the spread of a disease (such as a cancer), prevent the progression of a disease, and possibly even prevent death.
In the United States, some may be concerned with the cost-effectiveness of pharmacogenomic testing. Obviously it will be costly to test every patient, but only those with a disease would be tested. As explained by Dr. Barlow, the way the technology is applied in Taiwan has actually reduced their healthcare costs. If we used the technology similarly, we could use pharmacogenomic testing in HIV patients in a cost-effective way. The reduced hospital time, reduction in pointless medication costs, reduction in doctor-patient time, among others will all contribute to reducing the overall cost. The only added cost will be that of the test; once tested, though, many other unnecessary finances will be eliminated.
If I were a physician, I would use the pharmacogenomic testing for a variety of reasons. In providing treatment, it is necessary to do everything that is possible to help the patient. While the testing might be expensive, it has proven benefits. The article on pharmacogenomic testing in Taiwan indicates that in the long run, this testing has demonstrated to be cost effective. The article mentions Carbemazepine, which is a drug used to treat numerous conditions, including off-label disorders. The drug can cause a plethora of severe side effects, which could be dramatically improved by pharmacogenomic treatment. It makes sense to use treatment that will directly benefit patients and also keep long term costs under control. However, I do see that insurance coverage and reimbursement methods could prevent many physicians from using the technology. These barriers stem from financial concerns associated with the high price tags of genetic treatments. The United States health care system is already problematic and adopting the use of pharmacogenomic testing is something that does not seem feasible at this moment. I understand that many physicians are hesitant to utilize this testing because it is new and expensive. Though, with the possibility to improve health outcomes, it certainly warrants experimentation. In the future, if pharacogenomics is adopted into full practice, it has enormous potential to benefit society on several levels.
ReplyDeleteAlthough there is current resistance to this new idea of pharmacogenomic testing, I think that it is an innovative way to improve a healthcare system because it is cost-effective and has the potential to make physicians and patients lives easier. If I were a physician treating an HIV positive patient, I would use this new technology because of the beneficial potential it has to make the patients life easier. The current medication available for HIV patients is extremely expensive leaving the individual with no choice but to pay for a drug that is not even guaranteed to work. Like Jane Barlow states in her article, “a medication on the market may be effective in only 50% of the people who take it, although effectiveness may vary with the disease category”. Furthermore, if there were a genetic test given that indicated whether a patient would actually benefit from a medication prior to taking it, the safety and effectiveness of medication use would improve significantly. Not only would the safety and effectiveness of medication use improve, but healthcare costs would drop as well. This new technology would allow for physicians to provide the correct medication dosage, and therefore, fewer incorrect prescriptions would be given.
ReplyDeleteImplementing pharmacogenomic testing in the United States would be very difficult because of the structure of our healthcare system. I think there would be increased resistance from pharmaceutical companies, who would lose money if a genetic test like this were available. In addition, physician resistance is another barrier to implementing this technology in the U.S.; like the article mentions, younger doctors are the ones that tend to be more hesitant in using it. Another barrier would be resistance from insurance companies, who would then have to take into consideration covering this new test.
Although there is current resistance to this new idea of pharmacogenomic testing, I think that it is an innovative way to improve a healthcare system because it is cost-effective and has the potential to make physicians and patients lives easier. If I were a physician treating an HIV positive patient, I would use this new technology because of the beneficial potential it has to make the patients life easier. The current medication available for HIV patients is extremely expensive leaving the individual with no choice but to pay for a drug that is not even guaranteed to work. Like Jane Barlow states in her article, “a medication on the market may be effective in only 50% of the people who take it, although effectiveness may vary with the disease category”. Furthermore, if there were a genetic test given that indicated whether a patient would actually benefit from a medication prior to taking it, the safety and effectiveness of medication use would improve significantly. Not only would the safety and effectiveness of medication use improve, but healthcare costs would drop as well. This new technology would allow for physicians to provide the correct medication dosage, and therefore, fewer incorrect prescriptions would be given.
ReplyDeleteImplementing pharmacogenomic testing in the United States would be very difficult because of the structure of our healthcare system. I think there would be increased resistance from pharmaceutical companies, who would lose money if a genetic test like this were available. In addition, physician resistance is another barrier to implementing this technology in the U.S.; like the article mentions, younger doctors are the ones that tend to be more hesitant in using it. Another barrier would be resistance from insurance companies, who would then have to take into consideration covering this new test.
If I was a physician treating HIV positive patients, I would definitely try to incorporate pharmacogenomic testing and treatments. Pharmacogenomic testing along with the more customized approach to treatment it produces allows physicians to reduce the prescription of drugs that are ineffective and sometimes even harmful to some patients. As the article on pharmacogenomic medicine in Taiwan points out, coupling the use of expensive testing with inexpensive but effective drugs is justified, since it produces better health outcomes and less wasteful spending on ineffective drugs. As promising as pharmacogenomic medicine is, there are serious financial barriers to its implementation in the US. Many insurance providers do not cover the cost of genetic testing, which leaves patients with the option of paying high out of pocket costs for genetic testing and subsequent treatment or sticking with less effective but more affordable care. However, as genetic testing is becoming more common, easier, and affordable with the expansion of DTC testing (many of which involve a cheap and easy cheek swab) I think that pharmacogenomic testing/treatment will become a more common method of treatment in the US.
ReplyDeleteDue to advances in the area of pharmacogenomics, drugs now have potential for higher success rates. Patients are also able to receive more individualized care. The mapping of a person’s genome and its subsequent relation to medication allows doctors to customize a patient’s drug regimen. It goes without saying that the safety and effectiveness of the drugs, as well as the individual’s response, will be greatly enhanced.
ReplyDeleteAccording to the article, pharmacogenomic testing is becoming more of a legitimate process than the traditional method of disease predisposition testing. As physicians become increasingly aware of pharmacogenomic testing, it will continue to thrive. Though there are added costs associated with such treatment, the article makes a good point about these costs being offset by the savings that such tests would bring.
Though Taiwan has had success with the implementation of this method, there are many looming concerns regarding the use of such practices in the United States. The biggest concern is in relation to the diversity of the American people. The Taiwanese people are a much more homogenous population. This helps genetic testing because results have a lot less confounders and variability. Such a diverse population could greatly hinder the reliability and accuracy of such tests. Boundaries also relating to the adoption of such treatment methods in the United States include: skeptical physicians, privacy and consent laws, potential environmental barriers, and insurance companies.
Though the tests may not be as effective or successful in America as they are in Taiwan, I still believe they should at least remain a treatment option. The more choices afforded to doctors and their patients, the greater the chances are for success. For this reason, were I a physician, I would utilize the new treatment.
One of the most important aspects of using new technology is the effectiveness it has on the users. I think that this HIV technology was quick, easy to use, and would be beneficial to a vast majority of people, it should be used by physicians. Like posts before me have said, one of the main goals of a physician is to make his/her patients better and healthier. However, often times physicians are scared to use new technology because they may not be familiar with it and its effects of people. To ease this barrier, maybe physicians would go to conferences or other educational seminars in order to get more information. Another barrier in the US is that not everyone has primary health physicians and so they may not even know this technology exists, and if they do end up seeing a physician, they may not be able to afford to pay for this technology (as they may not have insurance, etc). Moreover, it would definitely be important for physicians to know that they are not just wasting their money on this technology and that they won’t get anything out of it (if they don’t know how to use it, if patients are resistant, etc.) There are so many new technologies, so why this one? That is a question that would need to be addressed before this technology became popular.
ReplyDeleteAlyson Rofrano:
ReplyDeleteI agree with most of the people in the class, that is if I were a physician i would definitely take advantage of genetic technology to improve a patients health in regards to HIV. However, I do recognize the concerns of some physicians and could see how one might hesitate with these new technologies because they are unfamiliar and each patient will respond differently. What Magy said above me is a good idea, that physicians should be required to attend a seminar to become more familiar with these techniques, because at the current rate, medicine and genomics will be close to inseparable in the near future. -Alyson Rofrano
Similar to what most people have said before me, I think that genetic technology is important in effectively treating patients. If I were a physician treating patients with HIV, I would use pharmacogenetic testing to treat my patients. I think that the more educated the medical community is on the drugs and how they work, the more effective the selling point is for the patient. This means requiring physicians to attend conferences and seminars on advancements in genetic testings and treatment options. The more options available to the patient, the better chance they have at fighting an illness or a disease. Futhermore, as the article stated, pharmacogenomic techniques can greatly improve a patient's outcome. The patients who had been tested and given the pharmacogenetic drugs were shown to have effectively reduced side effects during treatment. This shows how much more accurate treatment plans can become as physicians and patients learn more about genetics and personalized medication. It also decreases the use of ineffective drugs and the occurrence of potentially harmful side-effects. Additionally it is understandable that many physicians and health care officials are hesitant to adopt pharmacogenomic practices due to the high costs of genetic testing. However, I think in order for the quality of health care to improve an advancement such as this is needed in order for patients to receive the best care and treatment options available to them. All in all, I am in favor of pharmacogenomic techniques and I think they are necessary for improving patient care.
ReplyDeleteThe field of pharmacogenomics is racing ahead and we need to take full advantage of it. The health and economic benefits that result from pharmacogenomics are huge. Patients could find out if they would benefit from the use of certain medications, and what specific dosage would work best for them, leading to the most effective use of medications. By physicians and patients properly using pharmacogenomics there could potentially be better quality health care and less economic wastes in health care. For instance, patients who have human immunodeficiency virus (HIV) would benefit from the use of pharmacogenomics. Patients with this condition should be tested for a biomaker that would indicate whether their type of HIV is susceptible to drugs that would be prescribed to them. More specifically, a patient would not benefit from the antiretroviral drug maraviroc if their HIV strains bind to the T-cell receptor known as CXCR4. Knowing this before the drug is prescribed would save the patient from any unwanted side effects as well as savings in health care. Taiwan is drawn to the cost effectiveness of pharmacogentics and I think that we should follow in their footsteps. I think that there is hesitance with using this fairly new concept because most physicians are not too familiar with it. A Medco/AMA survey showed that older physicians are the ones ordering pharmacogenomics tests. This suggests that younger physicians are not as confident with the use of this testing. In order to benefit from the cost-effectiveness of pharmacogenomics we need to highly stress the importance of it to existing and future physicians.
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