In 2002, when Wired sent David Ewing Duncan to get the world's first top-to-bottom gene scan for disease markers, he called it a "sneak preview of a trip to the DNA doctor, circa 2008." Well, as usual we were a little too far ahead of our time. Gene scanning isn't yet standard practice. But over the past six years, medicine has been inching closer to Duncan's vision of a future where prescriptions are custom-matched to a patients' DNA.
Take the anticancer drug Purinethol: A variant in agene called TPMT causes one in 300 childhood leukemia patients to suffer life-threatening side effects from the med. So in 2004, the FDA required that Purinethol's label recommend genetic screening — which helps persuade insurance companies to cover the $395 scan.
In August 2007, the FDA made a similar recommendation for warfarin, a drug designed to prevent fatal blood clots but which can cause internal bleeding in patients with particular DNA mutations. However, like all pharmacogenetic tests, the scan for warfarin tolerance isn't readily available. Blood samples must be sent to a lab, and as Francis Collins, former head of the Human Genome Project, points out, patients at risk for blood clots can ill afford to wait a week for results.
In the next two years, Collins expects many more discoveries of DNA variations that affect our response to drugs. But there could be millions of them, so progress will likely creep along — gene by gene, pill by pill — starting with drugs that can either kill you or save you depending on dose. Collins is quick to quote the late futurist Roy Amara: "We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run."
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