Why is the PDR “still a thing?” Time for the Personalized PDR.

Mike Gillam, 27 March 2015

One afternoon in the emergency department, I saw a middle aged woman with an unsual complaint. “I have pain right here behind my right elbow and behind my left ankle.” She grimaced as I touched each area but they looked completely normal. It was odd that the pain would be so specific – so widely different – and so excruciating it would bring her to the hospital. Her only recent medical history was bronchitis. I suddenly felt that familiar rising “clinical itch” in the back of my head that there was an answer.

Levaquin, the medication she was prescribed, was known to cause tendinitis. A quick search of Pubmed revealed that hers was the first case of tendinitis that was bilateral. More than that, it reminded me of the incredible muscle aches my own grandmother experienced from cholesterol lowering medications. She had suffered for weeks waiting for the side effects to wear off.

Neither of them knew that their side effects could have been prevented. They were virtually “predestined” to experience these side effects.

Their fate was written in their genes.

Today, look at any side effect profile for a medication in the PDR and you will see a list of percentages. It looks like a gamble which side effect you might suffer.

Yet, almost every side effect is a product of a metabolic pathway. Few of these susceptibilities are acquired after birth. Granulocytopenia, pancreatitis, hyperkinesias, renal failure – almost all of these side effects can be predicted from your genome.

The world reached the $1,000 human genome in March last year in 2014.

Over 1 million genomes have been sequenced to date, and millions more are planned. The NIH tracks and shares the raw data showing that genomic sequencing costs have been dropping at a rate faster than Moore’s Law.

Raymond McAuley at Singularity University has predicted that if sequencing cost trends continue at current rates, sequencing a genome will cost less than the cost to deliver a pizza in the next few years and less than the cost to flush a toilet as early as 2020.

The cost for 23andMe’s sequencing kit is $99 which analyzes hundreds of thousands of SNPs (of the estimated 10 million known in the human genome.)

A Genomic Based PDR means patients would know exactly what side effects to expect with virtually certainty before taking a medication.

A global project to aggregate the side effects of medications across electronic medical records on a world wide basis and combine it with genomic information could deliver a PDR personalized to any patient.

In the future, no clinician would ever prescribe without a genomic PDR. The result would be fewer suffering grandmothers and a safer world for patients.

Is it time for the personalized PDR?

Mike Gillam, MD, FACEP 2015

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