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The Gains and Losses of Pharmacogenetics in Psychiatry Part Two : Obstacles

In the previous blog post, I spoke about misconceptions that many believe in when first looking into pharmacogenetics. Today, lets talk about how the implementation of pharmacogenetic testing may actually take place and the possible obstacles.

It is important to think about how genetic testing may lead to ethical dilemmas. Ethical dilemmas include doctors talking about how race increases or decreases chance of having certain diseases or cancers in the future,  or limitations of what genetic testing can provide. An example of the latter is explained by :

Knowing that a fetus has inherited 2 Cystic Fibrosis mutations, however, does not, at this time, predict the severity of CF in the baby. For couples in this situation, the ethical dilemma involves the decision to continue or to end a pregnancy without having knowledge of the severity of the disorder.

Although you know that they is a very high chance that you’re child has CF, you don’t know how prevalent that CF will be in your child’s life.

In addition to not being able to figure out the severity of genetic disorders nor the exact answer to the question if what you’ve tested for will occur, the way the report is built and given to the consumer is confusing to say the least as described by Dr. DelBello:

The red, yellow, and green light reports may seem like a simple way to describe pharmacogenetics results, but many patients seem to apply their own interpretation, especially in the absence of professional counseling and education. This can interfere with quality mental health care.”

What I am trying to showcase here is that without proper assistance, many patients believe that “green medications” are safe, “yellow medications” should be used only in certain circumstances, and “red medications” are to be avoided. In fact, Dr.DelBello urges people to see that “In some circumstances, a green medication may be a terrible choice for a specific patient, a yellow medication may be completely innocuous, and a red medication may be helpful, as long as the patient is given a very low dose or is willing to undergo periodic blood monitoring. Quite frequently, patients will fail to achieve a satisfactory clinical response from their first, second, or third medication trial. However, patients often are reluctant or even refuse to consider a “red” medicine because of misconceptions about what it means. This can shut the door to a potentially beneficial medication, perhaps the only one that will help the patient.”

If used correctly, the stoplight document is very helpful and easy to understand once explained. It can help lead patients to better treatment faster, more likely no more trial-and-error periods, and possibly cheaper in the long run, especially in the world of Psychiatry.

h/t Ethical testing    h/t pharma in psychiatry



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