Biology 101

I’ve been in the scientific field for 15 years and one of the things I’ve learned is that biology can be very difficult to comprehend. With how fast the field progresses, it is easy to get lost in the new technology. Therefore, I’d like to briefly discuss the concept of drug metabolism. Drugs are mainly metabolized by enzymes found in the liver. These enzymes come in several different flavors. Think of a door lock, each house on your block has a different lock therefore requiring different keys to enter. Enzymes are similar in that they have specific substrates (or doors in this example) they can open. Within a single person, there are thousands of these enzymes just hanging out in the liver waiting for something to metabolize. Plus the levels of these enzymes can increase or decrease due to stress, illness, or disease. Finally, just like people have different eye and hair color, enzymes and their capability to metabolize drugs can differ. The thousand-dollar word for the difference between brown and blue eyes and high or low metabolizing enzymes is polymorphism. Polymorphisms are small changes in the genetic code that leads to enzymes of differing activities.

            
With all these variables, it is close to impossible for a physician to know how you will metabolize and therefore respond to a given medication. Until now, doctors have relied on past patient experiences and what advice drug companies give them. And with all the new pharmaceutical interventions and the fact that a high percentage of people are taking more than one medication, the old fashion trial and error method of prescribing drugs is on the way out. Recently, scientists, scientists much smarter than me, have developed clever diagnostic tests to know exactly the profile of liver enzymes each patient has.  This is just the beginning of the idea of personalized medicine. These same techniques will soon revolutionize the way we treat cancers and certain diseases (but I’ll save that for another day). This new information will greatly improve patient outcome and change the face of medicine as we know it. Got to love the power of science!