Biotechnology Healthcare - November/December 2008 - (Page 6) mates that the return for most clients is 1.5 to Robert Wood Johnson Foundation to study 2 times their investment. clinical and ethical issues related to tailoring “It’s still a hard road, and you win in small smoking cessation treatment by genotype. increments,” says Cryer, but those increments Primary care physicians are among those tend to get bigger as the investment in smoking with the least experience with clinical genetcessation gets bigger. For example, the one-year ics, according to Shields. The short duration of quit rate for a smoking cessation program that office visits and lack of practice guidelines includes online and telephone counseling, nicocontribute to their disinclination to get into tine replacement therapy, and such smoking genetic testing and counseling. cessation drugs as varenicline, is about 7.5 perMoreover, it’s not just a matter of ordering “The biggest potential cent, compared to about 4 percent for a program financial return is in keep- a test that matches a patient with the most efwithout counseling or drug coverage. fective smoking cessation treatment. Some of ing people healthy and “My message to employers is to go where on the job,” says Hewitt’s the genetic variants that would be useful for taithe money is,” says Cryer. “The key is to get Michael Cryer, MD. loring smoking cessation treatments also are the right vendors, set up a stop-smoking proassociated with increased risk for other addicgram that’s got the highest probability for good outtions and psychiatric illnesses, such as attention deficit comes, and [develop a] strong measurement program to hyperactivity disorder, depression, and compulsive disormonitor the process and the results. If you do those things, ders. These pleiotropic associations would need to be exthen you’ll generate enough savings to cover your costs.” plained to obtain a patient’s informed consent for testing. Like Lerman, Cryer expects pharmacogenetic testing to “An individual may not want that additional information make smoking cessation therapy more efficient through generated about them or have it end up in their health the avoidance of drugs that don’t work for a given person. record,” Shields notes. “It might not be an issue now, but “Our clients say if it becomes a standard of care and it’s as new research comes to light, that information could be supported by clinical evidence, they’ll support it, but it will potentially harmful in the hands of the wrong people. Now primarily be administered through the physicians and the is the time to address the challenges associated with transnetworks that provide the care,” Cryer adds. lating pharmacogenetic treatment strategies into practice. Only if we understand these challenges will we be able to PRIMARY CARE’S ROLE reap the benefits of new, more effective treatments.” But what if physicians aren’t prepared to order these genotyping tests for their patients? And what if consumers REFERENCES Lee AM, Jepson C, Hoffmann E, et al. CYP2B6 genotype alters abare leery about the potential misuse of these test results? stinence rates in a bupropion smoking cessation trial. Biol Psy“Just the word ‘genetic’ actually posed a barrier to chiatry. 2007;62:635–641. adoption by primary care physicians, regardless of the Shields AE, Blumenthal D, Weiss K, et al. Barriers to translating emerging genetic research on smoking into clinical practice: perspectives characteristics of the test,” says Alexandra Shields, PhD, of primary care physicians. J Gen Intern Med. 2005;20:131–138. referring to the conclusions of two recent studies she Shields AE, Lerman C. Anticipating clinical integration of pharmacoauthored (Shields 2008, Shields 2005). “If primary care cogenetic treatment strategies for addiction: are primary care physicians don’t buy into genetically tailored smoking cesphysicians ready? Clin Pharmacol. 2008;83:635–639. sation treatment, then it won’t be offered to patients.” Shields is director of the Harvard/MGH Center on GeBob Carlson, MHA, writes exclusively about healthcare. He nomics, Vulnerable Population, and Health Disparities, lives near Zionsville, Ind. and principal investigator on a five-year grant from the Smoking cessation tops in health and wellness measures In a survey by the National Association of Manufacturers and the ERISA Industry Committee, smoking cessation was most often listed as the most successful of members’ health and wellness programs. It ranked ahead of programs designed to encourage weight loss, regular exercise, and reductions in blood pressure. Smoking cessation also offers the biggest cash incentives to employees, ranging from $5 to $600, with weight management closest behind. Overall, the average annual per-employee incentive was $192. The full report of the survey, “2008 Employee Health and Productivity Management Programs: The Use of Incentives,” is available at «www.incentone.com/surveyresults». 6 BIOTECHNOLOGY HEALTHCARE · NOVEMBER/DECEMBER 2008 http://www.incentone.com/surveyresults
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