Future of health

This week's assignment provides us with an opportunity to explore the future of health and health care. My role as a hospital pharmacy manager in an organization focused on patient safety allows me to participate in many initiatives that highlights the burden on the health system as a result of adverse events patients experience as a result of their medications. The same drug, taken at the same dose and frequency, can produce very different effects in different patients due to a variety of factors. If we can better understand the factors that affect individualized responses to treatment, we can minimize adverse drug reactions, thereby minimizing morbidity and mortality associated with medications.

The Human Genome Project (HGP) was an international research project that spanned over 13 years from its inception in 1990 to completion in early 2003.  This work branched out into other areas of research including pharmacogenomics: the study of how an individual's genes affect their response to drug therapy.  Pharmacogenomic testing presents the promise of personalized medication therapy where this information can tailor a patient's medication therapy.  This would mean having the ability to precisely select medication and individualize dosing to maximize efficacy while minimizing adverse effects.

Advances in genomic testing have both decreased the cost and increased accessibility of this technology to both health care providers and the public. A pharmacy in North Bay makes pharmacogenomic testing available to patients in its community.  A patient was interviewed who described her history of side effects from various drugs which mystified her physicians over the years.  She submitted a DNA sample for pharmacogenomic testing and when the results were interpreted by the pharmacist, she discovered that had a specific genetic makeup which caused her to metabolize some drugs slowly, resulting in a build-up of drug in her body and metabolized others quickly meaning that should would higher than usual doses to achieve an effect. Although pharmacogenomic testing is becoming cheaper, it still represents a significant cost to the consumer.  In Canada, pharmacogenomic testing is not publicly funded.  In Ontario, a major study (the IMPACT - Individualized Medicine: Pharmacogenetic Assessment & Clinical Treatment study), led by the Centre for Addiction and Mental Health, is being conducted and evidence gathered to test if pharmacogenomic testing can decrease patient suffering and reduce costs in the healthcare system associated with failed therapy and adverse drug reactions associated with psychotropic medications like antidepressants. The use of pharmacogenetic testing to guide treatments has been found to demonstrate cost effectiveness or cost savings.

With the advent of pharmacogenomic testing, another challenge is the approach to educating healthcare professionals on this emerging technology, clinical application and importantly, how to counsel patients on the interpretation and the impact the testing may have on them and their descendants. The Canadian Pharmacists Association (CPhA) has opined that pharmacists will be the lead healthcare providers in providing guidance to patients with pharmacogenomic testing results.  The CPhA has put a call out to pharmacy organizations across the country to incorporate pharmacogenomic education to pharmacy students, and to create continuing education modules for pharmacists in the community and in hospitals to effectively support and integrate pharmacogenomic testing into practice.

References:

Abraham, C. (2018, March 16). DNA on drugs: How genetic test could make prescriptions more precise. The Globe and Mail. Retrieved from https://www.theglobeandmail.com/canada/article-dna-on-drugs-how-genetic-tests-could-make-prescriptions-more-precise/

Cohn, I., Cohn, RD., Ito, S. (2018). Professional opportunity for pharmacists to integrate pharmacogenomics in medication therapy. Canadian Pharmacists Journal. 151(3): 167-169. doi: 10.1177/1715163518766376

Forani, J. (2018, June 9). New DNA test could end "trial and error" of antidepressant treatments. CTV News. Retrieved from https://www.theglobeandmail.com/canada/article-dna-on-drugs-how-genetic-tests-could-make-prescriptions-more-precise/

Verbelen, M., Weale, ME., Lewis, CM. (2017). Cost-effectiveness of pharmacogenetic-guided treatment: are we there yet? The Pharmacogenomics Journal, 17, 395-402. doi: https://doi.org/10.1038/tpj.2017.21