Thursday, July 10, 2008
Did anyone see the New England Journal of Medicine? They published an article on a new gene involved in atrial fibrillation. Don't know what A-Fib is? You have 4 Chambers in your heart.....the top 2 are called atria.....Atrial fibrillation can put you at risk for heart failure, heart attack and stroke.
The last of these is the most ominous. This is one of the major reasons people take Warfarin. Which BTW, can have up to 45% of your metabolism tested for by genetic analysis of CYP 2C9 and VKORC1....And recent studies support its use.
You can get your testing through DNADirect......even if your physician says there is no reason to test for it(They are dead wrong).....Some physician with the company will order it.....The question is, "Whose responsibility is it to tell results to the doctor who put the patient on Warfarin?"
Personally, I think you should be tested if you are on Coumadin or starting Warfarin (same drug as coumadin).... The FDA may now consider it standard of care.....
So this raises an interesting question. I have been against DTC testing with these GWAS studies......especially because they are not even close to mainstream excellent medical care.....but what about when the doctor isn't doing the standard of care? Doesn't a patient deserve the standard? Yes.....I want to remind everyone that the standard of care is the usual standard of practice in one's community. But if you listen to Dr Gary Marchant Law Professor at ASU, that all may be changing.
According to Dr Marchant, since we now have the internet....the "standard of care" may become what's usual practice in the nation.....or maybe even internationally...
So I put it out there for all of you........should we sell DTC genetic testing for a condition which may put you at risk for adverse events? Even when the doctor won't order it?
I can see the malpractice case now......."And why didn't you order the test Doctor?.......(doctor) Well.......you see..........the patient told me they had ordered it."
The Sherpa Says: Rare gene variants may or may not be helpful in understanding this soon to be epidemic condition. It is certainly a good family study. But, I think no one will be offering DTC testing of this gene variant.........It is just to rare. This Warfarin thing is going to get complicated now that a patient could technically order this online.......