Episode 211: 211. Pharmacogenomics Testing, PHASER,

Episode 211: 211. Pharmacogenomics Testing, PHASER,


(https://www.healthquality.va.gov/guidelines/MH/mdd/VADoDMDDCPGFinal508.pdf) clearly state there is insufficient evidence to support this activity and testing. This is mainly because of low quality evidence and concern of bias given commercially funded studies.

(https://www.aafp.org/pubs/afp/issues/2023/0100/poems-pharmacogenic-testing-antidepressants.html)

American Psychiatric Association Psychiatry.org - Genetic Testing to Improve Psychiatric Medication Choice

Harvard https://www.health.harvard.edu/blog/gene-testing-to-guide-antidepressant-treatment-has-its-time-arrived-2019100917964

First prime


As I mention in my response email PRIME the primary outcomes per clinnicaltrials.gov were depression remission at 24 weeks, which was not statically significant. And then a use of fewer medications that have a potential gene-drug interaction which from what I can find was a ‘theoretical’ interaction not an actual increase in adverse events. Effect of Pharmacogenomic Testing for Drug-Gene Interactions on Medication Selection and Remission of Symptoms in Major Depressive Disorder: The PRIME Care Randomized Clinical Trial | Depressive Disorders | JAMA | JAMA Network




“The PREPARE Study

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5113234/#:~:text=Open%2Dlabel%20placebo%20reduced%20minimum,0.02%25%20in%20the%20TAU%20arm. When patients were told they were getting placebo for back pain and it helped their back pain!


The current VA/DoD guidelines clearly state, “For patients who cannot tolerate a statin, we suggest a washout period followed by a rechallenge with the same or a different statin or lower dose, and if that fails, a trial of intermittent (nondaily) dosing”.

https://www.healthquality.va.gov/guidelines/CD/lipids/VADoDDyslipidemiaCPG5087212020.pdf (full disclosure and bias I helped write them)

N-of-1 Trial of a Statin, Placebo, or No Treatment to Assess Side Effects | NEJM was published in the NEJM and then a few weeks later Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials (bmj.com) was published in the BMJ.

Around that same time a publication in JAMA https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773490 showed that using pharmacogenetic testing resulted in no worse LDL levels (soft endpoint) at one year but also no better


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16. Outpatient Testing Part 2

16. Outpatient Testing Part 2

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15. Clinical Testing

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14. IV Fluids part 2

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Bottoms up on the last discussion on fluids and a review of a few of the trials that contribute to the current mindset in EBM. Andrew creates his own "Mike Tyson Theory of fluids" and Joe subscribes t...

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13. IV Fluids part 1

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A quick discussion one the topic of which patient to give which fluid. Review of studies from the 90s to 2014 with demographics including pre/post Operative, Septic patient and even Rattus Rattus. (th...

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12. Dexa Scan Part 2

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Hard topic and difficult discussion continues about reasonable intervention and evaluation of therapy for osteoporosis. Andrew starts right off with his personal recommendation on the screening of low...

10 Sep 20147min

11. The Dexa Scam

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Hard hitting discussion on the evidence on soft bones and the best screening and treatment options. This episode was broken into two parts because Joe needed to run a full NIH Stroke Scale on Andrew m...

1 Sep 201429min

10. Vitamin D Part 2

10. Vitamin D Part 2

Who and when to test. Dose and frequency along with route of administration of Vitamin D are discussed along with 12 studies of outcomes and complications/benefits of each. Joe discovers Andrew is bel...

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