Retrospective on Pharmacogenomics in Canada
Pharmacogenomics was formally introduced in Canada in 2014, when CAMH secured a large grant to study its utility for mental illness. The CAMH study, which used the Assurex test in the US (now Myriad Genetics) generated much hype. CAMH tested over 10,000 patients referred by 3,000 doctors. A few insurance companies and large employers participated in the study.
Soon after, other providers entered the market and sold their tests on a direct to consumer basis and made the case to insurance companies and employers that their test is the one to choose. Some insurance companies participated in pilot studies with some of the providers.
Unfortunately, pharmacogenomics never lived up to the excitement generated at the beginning. In retrospective, there were good reasons:
- Pharmacogenomics was really only pharmacokinetics. Most providers were basically testing to determine if the patient metabolized the drug in the plasma and cleared the drugs by the liver. For mental illness drugs, the early tests did not go further to test for brain proteins that are the drug targets.
- Providers delivered their results as transactions and not as health care. Generally, the test results were cumbersome and difficult to read by doctors; most doctors simply had no time for interpreting the tests.
Another issue was the oversimplification of pharmacogenomics. Unfortunately, individuals that knew little about the science were the ones that were entrusted to conduct due diligence on the outcomes.
Personalized Prescribing were one of the providers above; during the years from 2014 – 2018, we encountered disappointed patients and doctors. We had a tough decision to make; find the key for effective pharmacogenomics or fold.
Fate would have it that we had a retired pharmacist as a patient; he provided a very interesting insight. He remined us that pharmacogenomics is pharmacology and not just genomics. We brought in the pharmacists and they were extremely important; they highlighted facts that our geneticists never considered in designing our tests. The pharmacists also recommended how to implement the results in a health care setting.
We went back to the drawing board with a team of pharmacists and geneticists. We redesigned our test panel and this time we included a long list of brain proteins. We also designed our software to be a tool for pharmacists, who were expected to interpret the genetic results, guide patients, and produce clear recommendations that doctors can confidently adopt.
We launched our new comprehensive test and the pharmacist service in July 2018; we have tested about 900 mental illness patients to end of October 2020. Our results have been nothing short of excellent. We no longer have disappointed patients, and doctors readily adopted our pharmacist’s recommendations.