Head of Group Benefits, Manulife Canada
Few things change human behaviour the way medical knowledge can. Consider the ashtray. If we think back a few decades, before people fully understood the health effects of smoking, ashtrays were everywhere: in homes, offices, restaurants, even doctor’s offices. Today, the scarcity of ashtrays is symbolic of a significant change in habits, attitudes, and health. Similarly, I think in a few short years we’ll all look back and wonder how we took prescription drugs without first considering our personal genetic makeup.
The new era of personalized medicine
Advances in science and technology are bringing an unprecedented level of personalization to healthcare. Personally-tailored medicine is giving doctors new information, so they can prescribe treatments that are the best fit for your individual physiology.
One element of personalized medicine is pharmacogenetics, a somewhat science fiction-sounding word describing the process of looking at a person’s genetic code so doctors can understand how the patient’s body will respond to medication. I believe this is the future of the pharmaceuticals industry (including drug plans), and it promises both improved health for patients, and better use of financial resources for governments and private payers.
Applying personalized medicine to mental health
According to the Centre for Addiction and Mental Health’s Facts and Statistics, each week there are half a million employed Canadians who are unable to work due to mental health related challenges. This includes 355,000 people on disability1 and another 175,000 who call in sick2. We also know that about half (49%) of the Canadians who feel they have experienced depression or anxiety – the most common mental health issues – have not sought out medical help3. Making it easier for people to obtain treatment, in person and via new virtual healthcare options that connect patients and providers through computers and mobile apps, is part of the solution. But improving the patient’s experience when they seek that support is also going to help people get back to health, and get back to work, sooner.
Pharmacogenetics can be used to help doctors prescribe the anti-depressants or anti-anxiety medications that will produce the best results for their patients. This is much easier on the individual because it avoids the previous process: weeks of trials (and possible errors) where patients took a medication for a period, followed by an assessment of the drug’s effectiveness by the doctor. If the assessment was poor, the patient moved to the next therapy and the process repeated itself. This cycle can be difficult for people as they try to find the treatment that will produce positive results. It can affect their home life and family relationships, and it can lead to interpersonal and productivity problems at work.
Using pharmacogenetics, doctors are also able to quickly identify drugs that have an adverse effect on a patient. Adverse drug interactions are scary and potentially dangerous. They can result in hospitalizations, taking an obvious personal and financial toll on individuals, families, and the healthcare system.
Tailor-made medicine and your drug plan
I believe any innovation that puts the right medicine in the hands of patients sooner has a place in benefits plans. A Manulife pilot program, currently underway, is looking at the advantages to be gained when pharmacogenetics is woven into the drug plan, with a specific focus on disability.
In the Personalized Medicine Project, plan members suffering chronic pain or depression were invited to participate. This group of plan members includes individuals who are managing their conditions and are still actively at work, as well as a group that’s on disability and working with Manulife disability case managers.
Once enrolled in the program, an independent company runs the genetic test, and results and recommendations are shared with the plan member’s physician (results are not shared with the employer or with Manulife). The project’s goal is to measure how pharmacogenetics can improve the participant’s health, protect workplace productivity, and influence a successful return to work.
The pilot will run throughout the summer and into early fall, but the mid-point findings are promising. After results of the genetic testing were shared with doctors:
- Just over half (51%) of the patients’ prescriptions were changed – either the dosage or the type of medication. While the test, on its own, does not mean a change in dosage or medication is required, it provides another tool for the doctor to use.
- Almost three-quarters (70%) of the physicians said they are ‘interested’ or ‘very interested’ in the results of their patients’ genetic tests. This is important because physician awareness and training on pharmacogenetics is still growing. As well, the patients’ perception of the genetic testing and its influence on their prescription is ranked highest amongst plan members whose doctors are using the results.
It’s only the beginning
With advances in technology, the time required for genetic testing will decrease, as will the cost. In the future, I imagine a person will only need the genetic test once in their lifetime, and it might become part of their permanent medical record. Consider that it was only sixteen years ago, in April 2003, that the human genome was mapped. Only 50 years before that, James Watson and Francis Crick discovered DNA. Less than 70 years later, we’re beginning to see drugs prescribed in a manner that takes into consideration the way patients metabolize those medications, based on their own, unique physiology.
I’m sure the next generation will look back and wonder, “Why would you do it any other way?”
1Dewa, Chau, and Dermer (2010). Examining the comparative incidence and costs of physical and mental health-related disabilities in an employed population. Journal of Occupational and Environmental Medicine, 52: 758-62. Number of disability cases calculated using Statistics Canada employment data, retrieved from http://www40.statcan.ca/l01/cst01/labor21a-eng.htm
3Canadian Mental Health Association (2019). Fast Facts About Mental Illness, retrieved from https://cmha.ca/about-cmha/fast-facts-about-mental-illness