Dr. Uday Jani will present It’s All About You – What Does Personalized Medicine Look Like in 2018? Talks are set for 3 to 4:30 p.m., Wednesday, May 9, and 6 to 7:30 p.m., both at the Lewes library. The program is part of a continuing series of library talks, free and open to the community
Attendees will find out why “one pill fits all” is no longer an option as the newest advances in personalized medicine are explored. Jani will discuss the individualized approach to medical care, including an in-depth look at genetic, pharmacogenomics and gut-microbiome testing.
“Just like there’s no one diet that works equally well for all people, there is no one medication that provides the same outcome for all,” said Jani. “But with the many advances inspired by the Human Genome Project, we are now at the cusp of understanding how to use genomics to get the right dose of the right drug to the right patient at the right time.”
The promise of pharmacogenomics is being able to address the tremendous variability in individual response to drugs, and ultimately prevent adverse drug reactions that may be due to genetic predispositions.
Jani said, “Normal variations in the human genetic code can yield proteins that work better or worse when they are metabolizing different types of drugs and other substances. Even small differences can have a major effect on a drug’s safety or effectiveness for an individual patient. Your drug-metabolizing enzymes may be set to act in a completely different way than a friend of similar height and weight.”
Jani offers an example from the National Institutes of Health: The liver enzyme known as CYP2D6 acts on 25 percent of all prescription drugs, including the pain reliever codeine. There are more than 160 versions of the CYP2D6 gene, and many of these vary by only a single difference in their DNA sequence. When a person takes codeine, the body actually turns it into morphine to relieve pain, but if people have a certain variation of the gene CYP2D6, they are known as “fast metabolizers” who may create morphine at a dangerously rapid pace. Conversely, some patients with another type of genetic variation don’t get much pain relief because their bodies don’t process the drug properly.
“While significant progress is being made, the actual use of pharmacogenomics in primary care may be some years away,” said Jani. However, he adds, as research continues to accumulate, the medical community is hopeful that this information will eventually help guide prescription decision-making in a much more precise and personalized way. For now, pharmacogenetics testing is successfully being used in treatment of specific genetically influenced tumors, and for certain medications for cystic fibrosis, inflammatory bowel disease and HIV.
Genetic testing, which examines changes, or variants, in a person’s genes that may lead to illness or disease, is also progressing from an occasionally deployed tool to someday becoming part of a patient’s personal health record, according to Jani. In addition to laying the foundation for pharmacogenomics, genetic testing is used to identify disease carrier states for genes, important to the patient’s immediate family; inherited diseases such as heart disease or cancer; and risk of common diseases. And while direct-to-consumer tests such as 23andMe may be more limited in scope and predictive ability, they’re now firmly in the mainstream, fueled by a growing list of conditions available for risk factor analysis – celiac disease, Parkinson’s, alpha-1 antitrypsin deficiency, age-related macular degeneration and late-onset Alzheimer’s disease, among others.
Most important to Jani is the holistic approach to realizing the full potential of genetic testing. He said, “It will allow us to help patients understand their own genomes and work with them to develop plans for lifestyle modification, nutritional choices and medications that may prevent or delay disease. This empowers people to take charge of their own health in a way that wasn’t possible before.”
A board-certified internist who also practices integrative medicine, Jani appreciates the remarkable connection of highly advanced genomics testing to the ancient practice of Ayurveda. Written in Sanskrit more than 2,000 years ago, Ayurveda is an uncannily accurate precursor to today’s personalized medicine, with its focus on doshas, the characteristics and idiosyncrasies that make people unique.
“It was thought that the three doshas provide every living being with an individual blueprint for health, much like today’s genotypes,” said Jani. “Imbalance in the doshas indicated disease before it manifested, and specifically tailored recommendations for treatment were given to each patient, very different from what became our ‘one pill for all’ cure. All these years later, we’re seeing the wisdom of that approach in the form of genetics-based personalized medicine.”
Jani is in private practice at Shore View Personal Care in Milton. A board-certified Internist, Jani believes in treating the whole person – not just the disease – using an evidence-based integrative approach. He completed a two-year integrative medicine fellowship at the University of Arizona, recognized as the leading integrative medicine program in the world, followed by training at the Institute for Functional Medicine in Minneapolis, Minn. For more information, call 302-684-0990 or go to www.udayjanimd.com.