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CENTRAL PHARMACY AND CENTRAL COMPOUNDING CENTER

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For more information about these community pharmacy/education/wellness centers, contact:
 

Bill Burch, RPh
Jennifer Burch, PharmD
Sejjal Patel, PharmD
Donna Ferrell, RPh
Michael Verble, PharmD
Kayla Harris, PharmD
Ziyad Jabar, PharmD

Mynam Vuong, PharmD
Jhuvon Francis, PharmD

CENTRAL PHARMACY

2609 North Duke Street, #103
Durham, NC 27704
Telephone: (919) 220-5121
Fax: (919) 220-6307
www.centralpharmacy.com
 

CENTRAL COMPOUNDING CENTER SOUTH

6224 Fayetteville Rd, #104
Durham, NC 27713
Telephone: (919) 484-7600
www.centralcompounding.com
 

Call to schedule a consultation with our pharmacists.

Moving Towards Personalized Medicine

Imagine knowing in advance which medical treatments will work best for an individual patient—and which won’t. That’s the promise of personalized medicine. And that’s just the beginning, according to Dr. Jennifer Burch of Central Pharmacy and Central Compounding Center in Durham. She envisions a future where preventive and holistic care is tailored to individual molecular and genetic profiles.

Before using genetic tests with patients, Dr. Burch will test herself to determine how to use the information from gene
tests along with other test results. Here she’s preparing to evaluate the information provided through
Your Genomic Resource.

But she also acknowledges that “personalized medicine is still very much in the future. There has been amazing progress in understanding the impact of genes on our health,” she says, “but we still have a lot to learn about how our genes interact with environmental factors. Knowing somebody’s genetic make-up, how they metabolize things, their lifestyle—all are pieces of the puzzle.”

Powerful SNPs

“They didn’t teach genetics when I was in pharmacy school—didn’t even talk about it,” she says. “but, since then, we’ve mapped the genome and have come to realize just how influential individual genetic variations—called SNPs—can be.

“SNPs—or single nucleotide polymorphisms—are sort of like little ‘switches’ in an individual genome,” she explains. “The different SNPs present in an individual’s genetic profile can provide useful information in evaluating their predisposition to disease—by indicating what is working and what is compromised. And the range of their possible effects on health—from negligible to significant—is enormous. Sometimes they represent a very strong predisposition for a given disease; other times they act more like dimmer switches.

“And just as a SNP might predispose someone to a certain illness, environmental factors influence whether these ‘switches’ are turned on. How people eat, lifestyle choices, the toxins they’re exposed to, and the drugs they take—all can affect how the switches work,” she explains. “The science of epigenetics examines the complex interrelationships among the genome, external environment, and individual health. Understanding and applying epigenetics would certainly be a health game changer—bringing us to that world of ‘personalized medicine,’ but we’re still a long way from that understanding.”

Smaller Steps

 “So, we’re not practicing personalized medicine yet,” says Dr. Burch, “even though that’s been the buzzword for the last five or six years.” She does, however, point to several successes in applying more targeted genetic information on the treatment side.

Areas like cancer care have moved more quickly to apply these insights, notes Dr. Burch. “Researchers have developed new treatment options specifically for individuals with certain genetic variations and SNPs. So, cancer treatment now commonly incorporates genetic testing to match an individual to the best drug.

“Even mainstream medications can have genetic considerations,” she says. “With Plavix, for example—an anti-platelet drug frequently prescribed after a cardiac event—genetic testing can identify people for whom the drug won’t work. A specific SNP may prevent those people from metabolizing and activating the drug, so pharmacies and physicians now test for that marker before prescribing Plavix.

“Functional medicine and nutrition are two other disciplines that have begun to take advantage of genetic testing in a more preventive way, as with the MTHFR (methyltetrahydrofolate reductase enzyme) test. MTHFR polymorphisms affect methylation, which can hamper B-vitamin activation and use. This can lead to a variety of problems ranging from obsessiveness to irritability to birth defects to heart disease. The SNP can produce these effects, but it doesn’t have to—particularly when an individual receives the right nutritional support. “

Compounding Pharmacies:
Pioneers in Personalized Medicine

Compounding pharmacists like Dr. Burch have long considered the individual needs of each patient in formulating and tailoring medications, and thus already play a key role in moving towards the promise of personalized medicine—starting with personalized medications.

“Now,” Dr. Burch points out, “we have begun to incorporate pharmacogenetics, or the study of how people respond differently to drug therapy based on their genetic profile.

“We have already seen the value of more comprehensive genetic testing in our own consultative practice. Results can help us understand genetically-driven drug allergies or processing issues. It can also pinpoint which drugs—and what amounts of them—are likely to be most effective for a given individual.

“Sometimes the medication history itself can offer clues to a person’s genome. When someone says, ‘Oh, I’ve got a lot of drug allergies,’ and they pull out a list of 25 drugs with an adverse reaction, I start thinking that person has some genetic switch that’s not working as it should to help them detoxify.” In such cases, Dr. Burch may recommend further genetic testing to illuminate hereditary challenges and shed light on which medications might be more effective. She also can tailor both medication dosages and delivery mechanisms to the individual need.

Personalized Medications

“Some people don’t need the full dose of a particular drug because of these gene SNPs,” observes Dr. Burch. “They may need a third or a fifth or even an eighth of what the standard dose is because of how they metabolize it or don’t metabolize it. This can be particularly true with certain anti-depressants, where the patient is unable to tolerate a full or even a quarter dose, but they can’t break the tablet into small enough pieces themselves. For a sensitive patient, we can start them on a micro-dose to see how it affects them.” Dr. Burch considers refill history a good success indicator with micro-dosing. “If the drug is not working, people don’t come back and get it,” she explains, adding, “People do come back and get these lower doses!

“Genetic differences mean that some people require not just different amounts, but different formulations or delivery methods,” she says. “People with the MTR or MTRR variation, for example, may not be able to use or activate certain forms of B12, or absorb it properly when taken in a capsule. But we can make an injectable methyl B-12, which bypasses the digestive tract to deliver an already-activated form directly into the system.

“We see methyl B-12 injection used with autistic kids for its detoxification pathway properties with good outcomes,” she says. “That’s a huge advantage in the toolbox of anybody treating autistic children.”