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Pharmacogenetic Forensics

Over at Nature Medicine's Spoonful of Medicine blog, Stu Hutson examines legal questions raised by the forensic use of pharmacogenetics, citing the death of a three-year-old boy as a grim example:

A mother in Freiburg, Germany finds her three-year-old son comatose in a pool of his own vomit. She immediately begins CPR as his twin brother looks on. The ailing boy is rushed to the local university hospital where he is stabilized — his life ultimately saved by quick thinking. However, two and half hours later, his father returns home to find the twin brother dead.

Once physicians determined that both boys had ingested "dangerously high levels of codeine," pharmacogenetic tests were used to determine whether the mother was culpable of, perhaps accidentally, poisoning her sons with a common cold remedy, or if the brothers were unable to properly metabolize the drug. The test "revealed that the boys carried copies of the CYP2D6 gene associated with normal codeine processing, and had, indeed, received too much of the drug," Hutson writes, adding that the mother hadn't understood the dosing directions.

Steven Wong at the Medical College of Wisconsin tells Nature Medicine that he's "concerned that the lawyers behind some class-action lawsuits might try to insinuate that doctors of patients who suffered adverse reactions were negligent in not performing pharmacogenetic tests beforehand," even though genetic tests do not yet fall under the umbrella of "'standard of care.'"

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