One Man, One Medicine?

Steven P. Timmons

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By Steven Timmons

Lewis Carroll gave Alice many perspectives in his famous book, Alice in Wonderland. Alice fell down a rabbit hole and things were just not the same. Up was down and down was up. Big and small were one tick of the clock away from each other. You might think that modern medicine would be immune from needing to handle so many different points of view, but because each person has a unique genetic make-up, it is turning out that variation is to be expected when we consider the side-effects of a drug.

It can be difficult to get recent statistics on adverse drug reactions. In the modern world of lawsuits and TV commercials that encourage patients to sue pharmaceutical companies, how can we realistically expect anyone in the health industries to volunteer that a drug has been responsible for a specific severe side effect or death? Nevertheless, a 2011 study from UC at San Francisco’s Department of Medicine found that one out of every 200 of all visits to medical facilities were adverse drug event related. Looking back to a 1998 University of Toronto study, we see that one in every 300 hospitalized patients in the United States over a 30-year period experienced an adverse drug reaction resulting in death.

How can this be? Recent studies on genetic variation have shown that we are individuals, each having a different capacity to metabolize drugs. The effect of the drug in each person can also be different. Taking just one of many examples, let us look at the beta2-adrenergic receptor.

Drugs such as albuterol, which stimulates this receptor, are used to dilate the bronchi to allow easier breathing in various disease states. So far, at least 80 different polymorphisms (differences in genetic sequencing) have been identified in the genes that encode this receptor. A number of these have already been shown to affect the response to a beta agonist such as albuterol. Variations in these genes have been specifically linked to a three- or four-fold difference in the effect of beta agonist drugs on certain individuals.

A friend of mine recently underwent an endless battery of tests that failed to explain her symptoms: dizziness, extreme fatigue, headaches and confusion. She finally tried avoiding aspartame, an artificial sweetener, and all of the symptoms faded. There are actually published cases similar to this one, but the medical community could not find this “idiosyncratic” reaction in the list of possibilities. Perhaps she is incorrect, but at least she is healing.

Entire new areas of study have opened up, using gene sequencing to predict adverse drug reactions (Pharmacogenomics, Toxicogenomics). For now, such technology is far too expensive to use on every patient who receives a prescription.

Still, there is something we can do. We can realize that when an individual reports a reaction to a drug, or has a feeling about a drug, it might be best to believe them and proceed with more caution than the label might indicate. If Alice says she fell in a rabbit hole, well…maybe she did.

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