Friday, May 15, 2015
Personalized medicine will have a huge impact on how drugs are used because it allows physicians to tailor drug treatments. No more trial and error: instead of prescribing the same drug to all patients with a particular health condition and waiting to see if it works, they’ll be able to choose the one that will work best for their patient.
Personalized medicine is also known as genetic medicine, individualized medicine, patient-specific medicine and personalized healthcare, but according to David Levine, a healthcare management expert, “precision medicine” is the term most consistent with clinical practice. It involves classifying, understanding, treating and preventing illnesses based on individuals’ unique biological and environmental profiles. This is done through genetic screening for early detection of illnesses, which can then be effectively treated based on the patient’s unique genetic constitution, family history and genetic predisposition. Although the concept of personalized medicine isn’t new, human genome sequencing (mapping the location of genes in the human genome and finding the order of the bases in the genome’s DNA) has opened the door to new screening and treatment practices.
It’s safe to say that medical treatment will gradually evolve from a “one size fits all” approach to a more personalized one, with patients increasingly being prescribed treatment that best fits their genetic constitution and other unique predictive factors. Based on more accurate information, physicians can avoid prescribing drugs that may not be very effective—and may even cause serious side effects—for certain patients. With this more personalized approach, physicians will be able to better monitor their patients’ responses to treatment and the progression of their health condition.
Personalized medicine will have a huge impact on how drugs are used. Thanks to pharmacogenomics (the study of how a patient’s genetic profile affects their response to drugs), physicians will be able to treat patients based on their reaction to a given drug, their resistance and the desired effect. By doing genetic screening or by using biomarkers (biological parameters such as proteins or DNA used as screening or treatment response tools), they can better identify the most effective drug instead of prescribing the same drug to everyone with the same illness. These tests help doctors choose the best treatment and personalize it for the patient, prescribe the right dosage, and monitor the treatment’s effectiveness. A good example is organ transplants, where genetic screening is done on blood samples. These tests are non-invasive and less risky for patients than biopsies, and they also allow physicians to choose the best anti-rejection drug based on the patient’s condition.
From a screening standpoint, personalized medicine is very proactive. It allows healthcare providers to advise their high-risk patients to change certain habits or their lifestyle, or to undergo preventive treatment so they don’t develop the illness to which they’re predisposed.
The main illnesses currently targeted by personalized medicine
Excellent results have already been achieved with breast cancer and heart disease treatments. For example, biomarkers can reveal the overproduction of the HER2 protein, which is responsible for 30% of breast tumours. As this protein doesn’t respond to conventional treatment, chemotherapy is combined with Herceptin (trastuzumab), rather than with the drug that would normally be prescribed. Herceptin blocks the HER2 protein and reduces recurrences by 52%. There have also been good results with the treatment of other cancers, like melanoma and colorectal cancer.
The most encouraging advances in personalized medicine are being made in the areas of oncology, heart disease, neurodegenerative diseases (like Alzheimer’s), psychiatric disorders, diabetes, obesity, arthritis, and chronic pain.
Getting a genetic screening test
These tests are generally targeted, meaning they look for specific genes associated with certain illnesses. And they’re done at the request of a physician. Some private companies offer screening tests that don’t require a physician’s referral—all they need is a saliva sample. The cost of the tests varies and can be high. And they may only provide a partial reading. Some of these companies offer genetic counselling, with patients being told to exercise more and eat healthier to prevent illness—so the value of the tests is questionable.
The impact of personalized prescriptions on group plans
According to Mr. Levine, there are many advantages to personalized prescriptions. In 40% of conventional cases, patients stop treatment or don’t refill their prescriptions. With personalized medicine, physicians can write their patients a prescription and tell them, “This is the drug that’s most likely to work for you. You’ll start seeing results after a few weeks.” Because the patient knows the prescription is based on their unique genetic profile, they’re more likely to adhere to treatment, even if they have to wait for their health condition to improve. The Food and Drug Administration (FDA) has already approved 137 drugs that provide pharmacogenomic information (information on the type of gene the patient needs for the drug to be effective)1. All of these advantages will definitely help reduce group plan costs, improve employees’ physical and mental health and contribute to healthier workplaces, because of reduced drug waste, lower absenteeism rates, and fewer and shorter disability leaves.
The insurance industry’s position on genetic testing
According to the Canadian Life and Health Insurance Association’s Industry Code on Genetic Testing Information for Insurance Underwriting, life and health insurers in Canada do not require genetic testing, and prospective plan members don’t have to be genetically tested to apply for life or health insurance. However, if a person has undergone genetic testing and is aware of the results, they should inform the insurer of any relevant information the test revealed when they apply for insurance2.
According to Mr. Levine, genetic tests that provide information on the risk of developing a particular condition can be a double-edged sword when it comes to applying for individual insurance. That’s why these tests should only be considered if a physician recommends them (e.g., if someone has symptoms or a family history). The goal is knowing how to treat the condition rather than determining if the patient carries genes that put them at risk for developing that condition.
Government interest in genomics
The potential benefits of genomics advances are huge: reduced use of chemotherapy in 34% of cancer cases in women; 17,000 fewer strokes a year and $604 million a year saved in colorectal cancer treatments, to name just a few3. And the interest in genomics isn’t slowing down. Genome Canada, the federal government’s principal agency for funding genomics in Canada, has just announced that, over the next two years, it will invest $15.5 million in the creation of an “innovation network” of 10 research centres across Canada that will work together to advance genomics research4. A total of $31 million from public and private sources will be invested in the network. Besides working on new treatments and diagnostic tools, one of the main goals of this investment is to improve Canada’s bioinformatics capabilities to better manage and interpret the massive volume of new genetic sequencing data. Researchers will focus on identifying gene functions and their health effects. Recent advances in epigenetics (the interaction between genes and their environment) will also influence genomics research in Canada.
The impact of genomics advances on our healthcare system
Unfortunately, due to the challenges of introducing new technology into our healthcare system, these advances will likely have only a very gradual impact. There are a number of important factors to consider before personalized medicine can be fully integrated: related scientific and technological advances; public participation; managing the vast amount of data generated; integrating it into clinical activities; evaluating research conducted to date; and financing. There’s still a lot that needs to be done before we can take advantage of all the opportunities that genomics offers. And, while 90% of physicians are in favour of genetic medicine, 72% of them acknowledge that they don’t have the resources, knowledge or skills needed to properly integrate it into their practices5.
David Levine has been President and CEO of the Montreal Health and Social Services Agency, The Ottawa Hospital and Notre-Dame Hospital in Montreal. He is currently Adjunct Professor in the department of Family Medicine at McGill University and Clinical Professor in the Department of Health Administration at the University of Montreal. He is also President of DL Consulting, a healthcare management consulting group.
1. D.L. Strategic Consulting
2. CLHIA. (2015)
Industry Code on Genetic Testing Information for Insurance Underwritting
3. D.L. Strategic Consulting
4. Semeniuk, Ivan (March 31, 2015). «
Genome Canada to create “innovation network” of 10 research centres », The Globe and Mail.
5. QUEBEC NETWORK FOR PERSONALIZED HEALTH CARE. (2013)
Résultats du sondage aux médecins sur l’intégration des soins de santé personnalisés dans la pratique médicale au Québec. (in French only)