September 3, 2021•658 words
Reading time: 3-4 mins
It's been a while since I visited Listed.to. This is my 100th non-unlinked post, I believe.
I happened to read this post about assigning unique QR codes to every single person for mass tracking, with the examples listed being "medical records, bank account, shopping information, DNA".
As someone with specialised knowledge in health and healthcare, I want to comment on medical records and DNA in particular.
Having medical records and (pharmaco-)genetic test results as a QR code that you can choose to present to your healthcare provider is not necessarily a bad idea.
I understand that this can be a slippery slope with implications in privacy, personal choice, and surveillance. But there are legitimate reasons this can be beneficial to individuals.
I will give a case where such a system will bring benefits to healthcare.
Example 1: Codeine Metabolism and Dose
For example, each of us metabolise (deactivate or activate, depending on the drug) the medications we take into our bodies at a different rate (speed), depending on our genetic code.
As a result, the same medication dose can work vastly differently in different people- a person who metabolises a particular medicine quickly might experience no therapeutic effect due to their body breaking the drug molecule down too quickly, before it reaches a high enough concentration in our body to take effect clinically. A person who metabolises a particular medicine very slowly might experience toxicity (overdose side effects) with the same dose.
This is negligible for most over-the-counter medicines, but may be significant for prescription medicines.
Codeine is a good, well-established example of this. It's a painkiller, but is metabolised (activated) in our bodies into stronger compounds (including morphine, a much stronger painkiller). The CYP2D6 gene can vary (exhibit polymorphism) among different individuals, resulting in differents extents of codeine activation in different individuals. Someone who is genetically a poor metaboliser (poor activator) of codeine might get little to no painkilling effect. Someone who is genetically a rapid metaboliser (rapid activator) might overdose from typical codeine doses, resulting in morphine toxicity (bringing severe consequences, including death).
Example 2: Talazoparib and Breast Cancer Cell Susceptibility
Aside from metabolism and dose considerations, genetic testing can also determine whether particular medicines work for your condition.
Breast cancer, is a disease where therapy options have advanced far over the past two centuries. From surgical removal, to radiation, to less invasive surgery, to the first drugs, to the first targeted therapy options (specifically targets cancer cells), to now genetic testing to identify which type of drug or biologic (combination) works best against a particular individual's breast cancer.
Talazoparib (brand name Talzenna) is a drug that requires genetic testing to show that the patient has one or more particular breast cancer gene mutations (BRCA1 and/or BRCA2). Breast cancer cells with such mutations are susceptible to the action of this drug.
I haven't specifically touched on the importance of medical records and medical history as they were not the intended focus of this piece, but they are implicated in drug-drug interactions, drug allergies, etc., things that can be either negligible or life-threatening depending on the drug. Either way...
Instead of having each healthcare provider you come across run a pharmacogenetic test on you (for your own medicine safety), wasting precious and limited time and human/monetary/environmental resources, the patient could choose instead to provide a QR code that provides their verified genetic data and medical records to the healthcare provider, to allow for easier, safe prescription of a particular medicine.
How one accomplishes this in a private and secure manner is another issue, one which I am not an expert on. However, I'm confident that if implemented with privacy by design, such a system can bring benefits to many around the world.