Not everyone reacts to the same medication in the same way.
Benedryl makes some people drowsy and others wired. Antidepressants have no affect on 38 percent of patients.
Some people are more susceptible to addiction from pain medications while others get pain relief without getting hooked.
Plus, the genes that give some people red hair will also cause them to need larger doses of anesthesia to numb up.
While redheadedness is a visible clue how an individual will tolerate anesthesia, other genetic variations that affect medication reactions can only be determined by trial and error — sometimes dangerous errors — or genetic testing.
“Doctors were asking ‘why do I give the same drug to two different people and get two different results?’” Matthew Rutledge, MD Labs’ co-founder and president, said.
MD Labs is part of a new industry called pharmacogenetics that uses genetics to map specific genes involved in the metabolism of and response to specific drugs.
Rutledge and Denis Grizelj, co-founder and CEO, began MD Labs in 2011 as a toxicology testing facility for physicians nationwide. They expanded to pharmacogenetic testing in 2014, with the development of their proprietary genetic test Rxight (pronounced “right”), which maps genes that affect more than 200 medications.
“It will help people avoid medications that will do them harm,” said Rutledge during an interview and tour of MD Labs. “Secondly, they can avoid medication that will do nothing for them.”
With a swab of a cheek to collect genetic material, DNA is processed, amplified, and analyzed in the MD Lab, and genetic targets identified. The test can identify key genetic markers that dictate how a patient’s body metabolizes different medications.
Results are protected by HIPAA rules, and patients, after consultation, have access to their data on a patient portal on the MD Labs’ website.
Because it’s genetically based, Rxight is a once-in-a-lifetime test, said Grizelj.
Preemptive testing makes the patient’s genetically-based profile of drug reactions available to doctors and pharmacists before illness strikes and before a drug is prescribed.
“It’s the vision for the future,” Rutledge said. “A test early in life provides a lifetime of benefits.”
MD Labs is not the only company providing pharmacogenetics testing, but it is the only company testing for as many drugs and the only one to provide — in fact, require — consultation with a pharmacist.
“Reports are upwards of 15-18 pages long,” Grizelj said, and could be a challenge for a patient to interpret alone. Patients “don’t get a copy until they have a personal session with a pharmacist; that’s mandatory. … We’re the only ones offering Personalized Medication Review.”
Currently, MD Labs contracts with Saint Mary’s Health to offer the testing and consultation at both Saint Mary’s Regional Medical Center and Saint Mary’s Medical Group Primary Care Northwest Reno on Sharlands Drive. Pharmacists at those locations are Rxight Certified to administer the test and provide consultation.
MD Labs has similar partnerships throughout the country and is also in negotiations with major pharmacies to offer testing and consultation.
Pharmacists are trained to watch for drug interactions. Pharmacogenetics, which is now a part of pharmacy training, is a natural extension of a pharmacist’s services.
“But at the end of the day, the physician is responsible for adding or changing medication,” Rutledge said.
Pharmacogenetics is slowing gaining national recognition for its ability to take some of the trial and error out of prescribing.
Even the president is on board. In President Obama’s 2015 State of the Union address, he launched his “Precision Medicine Initiative,” which seeks to part from one-size-fits-all approaches to treatment and includes research in pharmacogenetics.
In May of this year, Rutledge and Grizelj met with senior leadership at the White House Office of Science and Technology Policy to discuss the Rxight test.
Interest in pharmacogenetics is gaining added traction as government and health officials seek to curb an epidemic in opioid addiction.
Based on twin studies, genes alone account for an estimated 45 to 50 percent of opioid addiction, according to an article by the National Institute on Drug Abuse.
Physicians only have a 50-50 chance of predicting who will become dependent on or tolerant to pain medications. With pharmacogenetic testing, the predictive ability increases to 74 percent, according to a press release from MD Labs.
The knowledge gained by genetic testing for medication reactions has also helped in the treatment of patients at St. Jude Children’s Research Hospital.
Not long ago, the hospital considered eliminating codeine as an option for children because 3-5 percent of its pediatric patients had adverse affects, including some deaths, Rutledge said.
The hospital now offers pharmacogenetic testing to all its patients, and 97 percent sign up for it. Besides helping doctors determine if codeine is safe for specific patients the St. Jude’s test also helps its physicians determine whether leukemia patients carry a gene that could affect how certain chemotherapy drugs are metabolized.
The field of pharmacogenetics is growing rapidly and the increased interest is also leading to expansion plans at MD Labs.
“We went from three of us (employed at MD Labs in 2011) to 100-plus in five short years,” Rutledge said.
Nationwide the company has 100-110 employees total, which includes about 55 people in the Reno office plus a sales force in offices in Chicago and Pennsylvania.
MD Labs owners see a future in which pharmacogenetics testing is routine. But for now, insurance coverage for the test is far from universal. Most customers seek out the test themselves.
“The challenge is making people aware that this is available.”