Stanford finds personalized approach to opioids better

Opioids: Stanford researchers find personalized approach a better way to prescribe painkillers – By Denise Dador – Dec 2019

This article demonstrates the importance of personalization for quality healthcare and shows that standards are inappropriate for medication choice and dosing.

Why do some people get addicted to opioid painkillers and others don’t?

Stanford School of Medicine researchers have developed an innovative program called the Humanwide Project. Through wearable technology, genetics, and other tools, it aims to personalize care and take the mystery out of how we work.

Debbie Spaizman was nearly sidelined by a health concern. Surgery was needed, but she hesitated due to how she reacted to pain medication.  

“My head would spin,” Spaizman said. “I really was foggy, and I had itching all over my body. But I had no pain relief at all.

To get answers, Spaizman enrolled in the Humanwide Project at Stanford.

The study flips the model on healthcare by personalizing treatment.

This is a critical aspect of healthcare that is threatened by efforts being made by healthcare corporations to standardize all patient care to make it simpler, less variable, cheaper, and thus eventually ineffective.

That includes a deep dive into pharmacogenetics.

Dr. Megan Mahoney, clinical professor of medicine at Stanford said: “Pharmacogenomics specifically tests for genes that look at the rate in which we metabolize drugs. It can determine the dosing of medications and also predict any side effects.”

Meaning our genes can play a big role in how we respond to medicine.

Meaning that standard doses are inappropriate and dangerous, either by giving too much medication or giving too little – either way, the patient suffers.

“We were able to identify the class of opioids that would work for her based on her pharmacogenomic makeup and then she was able to go through with the surgery,” Mahoney said.

“Twenty-five percent of patients had a change in their dose of medication based on the pharmacogenomics test,” Mahoney said.

This is more proof that medication doses MUST be adapted to each individual and that standards are not medically appropriate.

The U.S. Department of Veteran Affairs is making a big push to personalize medicine for its vets. The program will enroll those with a history of cancer but will also inform doctors how patients will metabolize other medicines they need.

Humanwide pilot project brings Precision Health vision to life – Stanford Scope Blog – Amy Jeter Hansen – May 2019

“Life-changing” is not a phrase you typically hear in everyday conversation. But that’s how Debbie Spaizman describes her experience as a participant in a Stanford Medicine pilot project called Humanwide.

The idea behind Humanwide is simple: clinicians partner with patients to pull together their individual data, from lifestyle to DNA, and create a comprehensive picture of their health.

This kind of partnership is crucial to the quality of healthcare and is undermined by the current practice of setting “standards” intended to apply to ALL patients.

The care team then helps the patient manage current health conditions and address future risks through a plan aligned with his or her personal goals.

Megan Mahoney, MD, Stanford Medicine’s chief of general primary care, led the design and year-long implementation.

In a paper in the Annals of Family Medicine, she and co-author Steven Asch, MD, outlined the early lessons of the year-long project, which involved 50 patients..

Stanford Medicine leaders invited a videographer and broadcast reporter to document the Humanwide journey through the eyes of Spaizman and four other patients. This clip offers a preview of their compelling stories, which are told through six video episodes, a 30-minute film and six podcast reports:

Spaizman and the other participants underwent

• genetic assessments that gauged their risk for cancer and other diseases, and
• a pharmacogenomic evaluation that determined which types of drugs are most effective for their individual biology and cause the fewest side effects.

Here we see that individuals react very differently to the same drugs and require different doses to get the same effects.

The patients also tracked key health metrics, such as blood glucose levels and blood pressure, using portable digital devices that beamed their readings back to their electronic health records for remote monitoring by care teams.

The teams, which included a primary care physician, nutritionist, behavioral health specialist and clinical pharmacist, used this data to inform each patient’s care.

They succeeded in identifying several previously overlooked health conditions and risks for different participants, from hypertension to heightened risk for breast cancer.

For Spaizman, the biggest discovery involved her reaction to certain types of narcotic pain relievers. The pharmacogenomic evaluation helped her doctors prescribe the right drug for her after a planned surgery, so that her pain was alleviated and she didn’t suffer unpleasant side effects.

With Humanwide, we’re able to focus on the whole human: who they are when they’re working, who they are when they’re playing, who they are when they’re at home.

HUMANWIDE | Precision Health | Stanford Medicine
Stanford Medicine  Precision Health  HUMANWIDE

Humanwide is a bold pilot project from Stanford Medicine that uses the latest science and technology to understand each patient, from lifestyle to DNA, and apply that knowledge to transform their health.

The embodiment of Precision Health, the Humanwide model combines cutting-edge tools of biomedicine with a data-driven, team-based approach to focus on what matters most to each patient. The goal: predict and prevent disease before it strikes.

Each person’s DNA contains a wealth of information about his or her health risks. In Stanford Medicine’s Humanwide pilot project, primary care teams used genetic screenings and other assessments to create a comprehensive portrait of each patient’s current and potential health concerns, with an eye toward predicting and preventing disease.

Humanwide FAQs