Preventing, Diagnosing and Treating Disease Are Soon to Change Forever
Held at the VPL Central Branch on Oct. 7, 2015, this edition of the LSI Public Talks aimed to bring the Personalized Medicine Roadmap to the public, informing them about specific near-term benefits of personalized medicine. An expert panel including Dr. Pieter Cullis, Joyce Drohan, Rennie Hoffman, Dr. Martin Dawes, and Chris Wagner, was moderated by Pamela Fayerman, Medical and Health Issues Reporter for the Vancouver Sun.
The Roadmap makes four recommendations:
1. The government should make a whole system commitment to implement personalized medicine
2. B.C. should establish a coalition of stakeholders to coordinate whole system change by addressing policy, regulation, privacy, education and economic issues and barriers
3. B.C. should capitalize on near-term opportunities to integrate molecular medicine technologies into healthcare treatment
4. B.C. should establish a longitudinal database of molecular medicine and healthcare data for British Columbians to drive patient-centric healthcare, translational research, and innovation
Pamela Fayerman, Vancouver Sun
Prior to the event, Fayerman published three articles about personalized medicine on her blog, with one appearing on the front page of the Sun’s October 2 edition:
Speakers and Discussion Topics:
Dr. Pieter Cullis (starts speaking at 0:30 in the video)
Director, Life Sciences Institute (LSI), University of British Columbia
Chair, Personalized Medicine Initiative (PMI)
Dr. Cullis has co-founded seven biotechnology companies, published over 300 scientific articles and wrote The Personalized Medicine Revolution, a book written in clear, accessible language. He co-founded the Personalized Medicine Initiative (PMI) to implement molecularly based medicine into clinical practice in BC. Dr. Cullis has received many awards and was elected a Fellow of the Royal Society of Canada in 2004 and was awarded the Prix Galien, Canada’s premier prize for achievements in pharmaceutical research and development, in 2011.
What is the most revolutionary thing about personalized medicine from your point of view?
Cullis said the most revolutionary thing about personalized medicine is that we are moving from a “one size fits all” medical system to one that starts to deal with the fact that we are, in fact, quite different from one another. This is the first time in human history that this has been possible and it is enabled by dramatic technological advances that allow us to get our genomes sequenced, hundreds if not thousands of molecules in our blood, urine or other body fluids measured and thousands of bacteria in our feces analyzed, all for prices that are increasingly affordable. Present in all this molecular data is information regarding your risk of disease, diseases that you are trending towards, diseases that you actually have and whether therapies or lifestyle changes are actually working for you.
Personalized medicine will empower the individual to take care of their own health because they will actually have reliable data available to themselves that they can use to guide their own healthcare program. Much more precise diagnostics will allow early detection of disease. Therapies will be much better matched to disease and people will be treated more appropriately, taking into differences in gender, age and ethnic background automatically. All of this will enable preventive healthcare.
Joyce Drohan (starts speaking at 17:31 in the video)
Healthcare Practice Leader in British Columbia for PricewaterhouseCoopers (PwC)
Drohan has over 20 years of experience in strategy development and end-to-end large-scale transformation in central government and private sector in the United Kingdom and Canada. Drohan has previously held senior roles at AstraZeneca and with the Department of Health in the England, including Senior Advisor and Policy Director for Improvement and Efficiency and was also a regular guest lecturer at the University of Westminster (London, England) on health policy.
Where does this fit in with all the changes and innovations that are happening in healthcare today?
There are demographic changes with people getting older, sicker, fatter so more patients will need to be treated more effectively without wasting time and resources. Personalized medicine may be the key for some disease areas. The Technology Revolution has brought fast and easy access to information and technology. Patients are able to in increasing numbers view information from multiple sources and monitor their own health in some cases. Personalized medicine and its benefits may become well known quickly, and information is spreading at rapid rates. How will this be managed or regulated? A Power Shift is happening in which consumers are empowered. Patients now have access locally to global resources for genetic testing and treatments. What will be the demand for these services? Patients may not be patient enough to follow the traditional routes to get access to personalized medicine. If this is the case, then who is delivering care? How will government either respond to this or enable it?
Rennie Hoffmann (starts speaking at 21:58 in the video)
Executive Director, Better Pharmacare Coalition
Hoffman was a member of the Vancouver Police Department for nearly 29 years. After retirement he became the Executive Director of the Mood Disorders Association of BC and currently serves as Executive Director of the Better Pharmacare Coalition, whose mission is to ensure equal access for all British Columbians to the best medications in the most timely manner.
What will personalized medicine do for patients?
Hoffmann linked the sketch of the ‘Brave New World’ opened up by Cullis and Drohan with the actual real world applications of Dawes and Wagner (see below) by outlining and contrasting the historical experience of the patient in the healthcare system with the potential that personalized medicine can have. How should the needs and rights of patients be incorporated in the question of who pays what?
All patients do not respond in the same way to medications. One of the largest components of emergency room services has to do with adverse drug reactions. 33% of patients do not respond to generic substitution. For these patients any mandated policy of assigning drugs based on disease classes rather than patient need is not only not helpful but also may be damaging to patient well-being. Certainly with chronic illness if you’re not getting better, you’re probably getting worse. A personalized medicine approach will increase the likelihood that a medication will work properly for you.
Dr. Martin Dawes (starts speaking at 31:06 in the video)
Clinical Lead, GenXys
Dawes is Royal Canadian Legion Professor and Head of family practice at the University of British Columbia. He ran the UK Centre for Evidence-Based Medicine in Oxford, England and was Head of family practice at McGill University before coming to UBC in 2010.
How is all we have heard about actually going to happen?
Dawes’ work is about translating genetics to practice so that health professionals can help you have tailored treatments to match you and your needs. He has developed a pharmacogenetic test for multiple common diseases such as hypertension, as well as a software application to translate that test information into a list of the safe effective medication options for you. There is strong evidence that using genetic tests to guide prescribing is clinically and cost effective at reducing adverse events and improving effectiveness of medications. The next steps involve making this available to patients and professionals.
Read about GenXys and the application of pharmacogenomics in family care
Chris Wagner (starts speaking at 37:00 in the video)
President & CEO of Contextual Genomics
Contextual Genomics was founded in Vancouver and delivers DNA based testing for cancer across Canada and in other countries around the world.
Is looking at cancer a good place to start with personalized medicine?
Wagner explained that looking at cancer is a very good place to start with implementing personalized medicine and identified some of the barriers in bringing personalized cancer treatment to BC. The science and technology are no longer an issue; DNA sequencing is accurate, cheap and easy. Medicines are available in BC that specifically target mistakes in DNA that cause cancer. Changing the medical system and introducing new technology is now the limiting factor. The National Access Program http://personalizedmedicineinitiative.ca/the-personalized-medicine-initiative-and-contextual-genomics-announce-a-national-access-project-for-cancer-testing/ for cancer testing is a way that Contextual Genomics is facilitating the introduction of new technology across Canada. 2000 Canadians are being tested and oncologists are getting to use the tools. Our hope is that when people see how effective this technology is, it will accelerate the pace of change. This will raise the bar across Canada and improve cancer outcomes.
A Partnership Event: