Change will come, but it needs to come sooner

Published 10:53 pm Thursday, May 3, 2018

Mississippi spends about $350 million dollars a year on prescription drugs through its Medicaid program.

Unfortunately, a huge percentage of that money is wasted because the drugs don’t work. A mouth swab genetic test could fix that, but progress is slow in our state.

Expensive drugs such as statins, diabetes medications, blood thinners, antidepressives and the like are covered under Mississippi Medicaid but the genetic tests that can determine whether they work aren’t covered.

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More progressive states such as Texas and Georgia have figured this out. As a result, the right medications are getting prescribed to the right people. Mississippi should do the same. It could save $100 million a year and vastly increase the health of hundreds of thousands of patients.

We all know about genetic testing. It’s producing new miracles every year. Now a genetic test done by swabbing the cheek of your mouth can determine what medications will work for you and which ones won’t.

The results are staggering. As it turns out, about a third of the prescriptions are ineffective because of genetic variances among individuals. Worse, they cause bad side effects.

A recent Mayo Clinic study regarding depression found a 70 percent improvement in results when genetic testing was done to determine what drugs would work best with what patient.

It has to do with enzymes in the liver. About half of all drugs must be synthesized  by enzymes in the liver to work. If you don’t have the right enzyme, the drug will not only not work, it will cause bad side effects.

About a third of the people lack the right level of enzymes for many of the best-selling drugs to work, so a third of the money spent on prescription drugs is wasted. A genetic test, costing anywhere from $1,200 to $1,800 can fix that by identifying which patients have which enzymes. No doubt the cost will come down as time goes on.

I have personal experience with this. My son was given medications relating to autism. His condition dramatically worsened, precipitating a crisis.

I was blessed to have a close friend, Bob Crisler, who has a company in the genetic testing business. He walked me through the process and got me to insist that the psychiatrist do the genetic testing. As it turned out, my son lacked enough enzymes to metabolize the drug. Not only was the drug not helping, it was hurting. With the test results in hand, I insisted that his medication be changed. The difference was staggering. Within a few days, he recovered and has been fine ever since. “You saved his life,” I often tell Bob.

Here’s another example: I use an old-style antihistamine, chlorpheniramine when I can’t sleep. It’s old, cheap and over-the-counter. When my wife Ginny was having insomnia, I suggested she try it. It made her bounce off the walls.

As it turns out, chlorpheniramine requires a genetically-coded liver enzyme to work. I have it. My wife doesn’t. So we had dramatically different results.

The same is true with statins, diabetes drugs, blood thinners, ADHD meds, blood pressure meds, mood stabilizers and many other commonplace drugs. Hundreds of thousands of Mississippians are taking the wrong drugs, wasting millions and furthering disease. What a shame.

My heart goes out to all the people who are suffering from the wrong medication. As a practical matter, Mississippi could save millions in Medicaid expenses if they took an aggressive stance toward genetic testing. Less trial and error. Fewer hospital visits. Better health.

In essence, genetic testing can vastly improve medical results by getting the right medications to the right people. This will improve results and save money. But change is slow. There is resistance in the medical community. People fear change. Technology can be threatening.

But change will come. It’s hard to stop progress. A good first step would be for the Mississippi Department of Medicaid to embrace genetic testing and designate it a covered procedure.

Wyatt Emmerich is a columnist, writer and publisher in Jackson. He can be reached at