Pharmacogenetics testing and Healthcare System Navigation
By: Karen Adams
COVID 19 has changed all of our lives in many respects, including creating a heightened focus on the value of maintaining the health, safety, and wellness of our society. Now, more than ever, we are conscious of any factors that may put our health at heightened risk, and increased focus is being placed on designing our healthcare system to be easy and safe for all to navigate.
The pandemic has forever changed the healthcare landscape, and its impact extends far beyond our current situation. It has created an unprecedented sense of vulnerability among us, while simultaneously driving our understanding that each of us needs to become more participative in safeguarding our own health and well being, and take an active role in ensuring we get the best care in the event our health is compromised.
As we inch toward a post pandemic era, there is a growing awareness that each of us responds to viruses (and to the treatments used to fight them), differently, and that these individual variations in response can often have genetic roots. There are also many longer term consequences of this pandemic that will need to be managed effectively, such as the significant back-log of surgeries and medical procedures, a tidal wave of new and worsened mental health issues, and chronic conditions that have in many cases worsened due to “putting off” of seeking medical attention or lack of access to treatment.
One of the biggest opportunities we have to safeguard the health of Canadians as we face this surge in health issues is to ensure that any medications prescribed to us are both efficacious and safe. Adverse drug reactions (ADRs) are not only the #4 cause of death in Canada, but also result in significantly longer hospital stays and in extended disability. Up to half of ADRs are estimated to be driven by genetic factors (the presence of genetic variants that result in increased risk of side effects for individual patients.) Equally troubling is the fact that wide variations in individual responses to drugs mean that up to two thirds of patients receiving treatment for mental health or pain conditions fail treatment, necessitating weeks, months, or even years spent trialing different drugs and doses before seeing significant improvement.
The science of pharmacogenetics (the study of interindividual variations in the DNA sequence of our genes, and how those variations impact our individual response to different medications) offers individuals and clinicians the opportunity to side-step many of these issues, which have up until now been viewed as an “inevitable reality” of drug treatment.
A recent article from the Canadian Pharmacogenomics Network for Drug Safety published in the April issue of the Family Physician Journal emphasized the importance and value of the adoption of pharmacogenetic testing into Canadian clinical practice, and into our health care system and processes. The authors stress that “Ultimately, increasing accessibility to pharmacogenomic tests means better profiling risks of therapy before therapy begins and provides the potential to drastically affect the use of medication by making it safer, more effective, and personalized. “Given that drugs are used across all medical disciplines, pharmacogenomics should be the highest of priorities in both patient care advancement and federal investment in research".
The articles concluding statement seems particularly timely, as we brace for what we now know will be an extended period of heightened health risks and search for ways to optimize our processes and systems to better protect the health and well being of Canadians “Ordering pharmacogenomic testing will allow physicians to continue prescribing highly effective drugs with well understood safety profiles in patients determined to be at low risk of experiencing ADRs, while choosing alternative drugs and avoiding potential harm in patients at high risk. It is an ethical responsibility for all of us—clinicians, hospital administrators, and policy makers—to provide access to this service to all Canadian families to help prevent serious ADRs when battling diseases and illnesses that require medication."
It has become more imperative than ever that we ensure patient care pathways are optimized. This will only be achievable if we adopt innovative approaches and utilize all tools available to us to ensure the right patient receives the right treatment at the right time. Ensuring that pharmacogenomic testing is available to all Canadians will be an imperative to optimizing our collective health, care and recovery.