Pharmacogenomics – Your DNA on Drugs

April 27, 2016 Steven Laird

In the workplace, DNA testing can be a minefield. There is information in DNA that could negatively impact a career. An employee would require absolute confidence in privacy, protecting disclosure of potential career limiting information, such as pre-disposition to an expensive disabling disease. DNA testing raises the opportunity for discrimination. While legislation is in place to limit discrimination, when an employer is choosing between two equal candidates, DNA results that do not show a predisposition to illness could give an advantage to one candidate over the other. It can even give the perception of disadvantage when none exists. This is a liability employers do not need.

Have you thought about your DNA? There are companies advertising DNA tests to learn more about yourself and your ancestry. Do you want to know if your ancestors were Scottish and not German? Are there other things in the results of that DNA test that you don’t want to know and more importantly, that you don’t want other people to know?

DNA testing is fast becoming the next bone of contention among employers, employees, insurers and, no doubt soon enough, lawyers. Privacy and discrimination concerns top the list – but I’m not sure they need to be.

“Pharmacogenomics is a great example of the positive impact of new technology.” Lizann Reitmeier, National Health Practice Leader, Canada

DNA testing is quite interesting. DNA holds the secret to how your body works, who you are related to, and where your ancestors came from. Perhaps even more importantly, your DNA shows what diseases you are predisposed to and what drugs will have the best results if you do get certain diseases.

What your DNA doesn’t show is how those diseases you are “predisposed” to are triggered or when they will manifest themselves. As our knowledge of the cause of many medical conditions is limited, does knowing you have a marker for one of them change the outcome?

Should insurers require DNA test results?

Similar to requiring you to disclose any medical condition you already have, insurers are saying they want to know the information revealed in DNA testing.

I have some concerns with this, as I think it is an opportunity for discrimination. Suppose I have a DNA test and it shows I have a marker for cancer. This would not be a big surprise. My father died from cancer at 75 and his father died from cancer at 81. And this is information that an insurer could get from me through collecting family history. So, if I take a DNA test and it shows a marker for cancer, I have to disclose this when I apply for insurance. In the meantime, I am aware that 40% of cancers can be avoided through lifestyle choices like eating fruits and vegetables, exercising regularly and not smoking. So I am declined for insurance that would protect me and my family during my prime earning years, but I live into my 80s due to my healthy lifestyle.

But what if your DNA contains information that will cure your illness? Wouldn’t it be reasonable to take the test if it could shorten your period of illness and expedite the appropriate treatment? Wouldn’t the cost of a DNA test (at about $500) be in the best interest of all the benefit plan stakeholders, employers, employees and insurers, if it meant that there was no trial and error to determine the right cardiology/gastroenterology/oncology/psychiatry drug the first time?

This type of DNA testing is limited only to determining the effectiveness of drug. It won’t tell you if you should buy a kilt, or what colour your eyes are, or if you are carrying a medical condition that may or may not shorten your life. Does this test cause any concerns? Is there any privacy risk?

Pharmacogenomics – a more positive approach

This field of science is called pharmacogenomics. It has already been widely adopted in some other countries and some health insurers/PPOs in the U.S. make it part of the prior authorization protocols for certain drugs. When the right drug can be life-changing, such as some of the psychiatric drugs, or life-saving, like some of the cancer drugs, time is of the essence. For employers, the right treatment for the right person at the right time means savings through reducing durations of absence and reduced drug wastage. For plan members, this means medical conditions are addressed more quickly and, hopefully, restores an improved quality of life.

The current conversation in Canada regarding this technology includes both who has a right to this information and who is going to pay for the test. Insurers, naturally, are reluctant to take on additional expenses. Given the Canadian “healthcare is free” mindset, plan members will also be slow to take on this expense.

Yet this testing could be an important addition to an employer’s benefit plan. With a significant ROI, particularly for mental health drugs, it would be an ideal partner in the drug claim approval process. It could also be a great component of a wellness program. Mental illness is often initially treated with drugs that are at best ineffective and at worst damaging to the patient. By streamlining medication trial and error, an employer is supporting both the patient and their family in the best way possible. This simple test can eliminate stress, speed recovery, reduce disability days and eliminate drug waste.

Pharmacogenomics is a great example of the positive impact of new technology. While we can only see the additional cost and the risk to private information at this point, in the future, I expect this will be a standard protocol that advances the health and wealth of plan members and employers.

I welcome your thoughts on the application of pharmacogenomics – and I hope you never need them. Stay healthy my friends!

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