By Gustavo Bernard Esquivel, MD, PhD, MHA
Chief Medical Officer, GenXys Health Care Systems
Precision prescribing used to be a trending vision; now it’s a necessary reality.
Patient-centered care has never been more critical; it requires providers and care teams to adapt care plans and interventions to the pandemic’s impact on individual patients, especially those at higher risk due to age or chronic diseases. But patient-centered healthcare can’t exist without precision prescribing. How can healthcare be patient-centered if providers aren’t considering all relevant patient information, like susceptibility to medication side effects or treatment response biomarkers, to make care decisions?
Today, healthcare is forced to adapt to the effects of COVID-19. We must optimize our services to address the delays in, and barriers to, healthcare due to the massive COVID burden we are currently experiencing. It’s pretty obvious from a cost-effectiveness standpoint, a quality standpoint, and an overall survival-rate standpoint, that we need to be more accurate and precise in our prescribing. We have neither the time nor the resources to maintain the centuries-old trial-and-error approach to prescribing. We now have extra weight on our shoulders demanding the best measure of our healthcare resources. We must ask ourselves: “Am I willing to have a patient occupy an ICU bed because of an adverse drug reaction?”
While COVID-19 placed an enormous burden on the healthcare system, the pandemic has also accelerated positive change in how we practice medicine. Number one, I think COVID-19 helped providers understand the clinical utility of clinical genomics in not only creating the SARS-CoV-2 RNA vaccine, but also sequencing and characterizing the alpha, delta, and omicron variants. We will see RNA technologies disrupting the cancer prevention field in the near future.
Number two, COVID-19 exposed healthcare’s lack of disease prevention. We are all too comfortable to react rather than predict and prevent. I think that is important to keep in mind. Adverse drug reactions represent five percent of deaths in the U.S.[1] Five percent of deaths from adverse drug reactions. That is astounding, especially when there are tools to help right now. There are clearly ways we can prevent this. Should we continue waiting until the problem becomes worse, or is now the time to finally start taking action?
Pre-emptive care is crucial. We should start preventing adverse drug reactions with predictive personalized medicine and modeling based on patient data. This will inform how a patient will respond to specific medication without having to wait and see. We have the information to know with a very high accuracy before it is prescribed. Additionally, we are developing FDA-approved drugs that are based upon the average response rate of very large cohorts of people. You have a mean dosing recommendation, and that’s it. The FDA has done a fantastic job pushing the industry to be as inclusive as possible in terms of diversity, but in the reality of clinical life, the mean dosing recommendation isn’t always correct. Every single patient is unique, and we must adapt our practice to the individual. So, we need to start treating the person rather than diseases.
The third positive change from COVID is the power of technology in how we interact with our patients. Our acceptance of and attitudes toward telemedicine changed dramatically in the wake of the pandemic. Nowadays, I’m still seeing patients in person, but we have improved care access and patient comfort through telemedicine. It simply makes sense. Right now, the tools, platforms, security, and privacy are sufficient to facilitate these types of medical visits. Interoperability remains a hurdle, but one that is being successfully navigated by the modern health tech companies.
We should be fostering the implementation of technology within healthcare as much as possible. For example, clinical genomics can estimate a patient’s risk of developing disease, and pharmacogenomics can predict a medication’s effect on the individual patient. This is transformative technology. For instance, with clinical genomics, I can test a patient with Ashkenazi Jewish heritage with an increased risk of developing hereditary breast cancers. I can test a female as soon as she’s born, and I can identify that mutation. That’s predicting risk before the patient has developed the disease. Indeed, a mammogram can be an effective tool to identify cancer at an early phase so that we can be reactive in treatment. This is the best-case scenario from the reactive standpoint—treat promptly and stop the cancer. But today we can incorporate genomic information, identify the risk, and implement preventive strategies to a) avoid the disease diagnosis altogether, or b) delay the onset as long as possible. Pharmacogenomics can use this same predictive power to avoid the trial-and-error approach to prescribing altogether.
We have access to all sorts of information nowadays, but all the information in the world is useless if it can’t be efficiently interpreted and accessed. Software and other technologies are well-suited to solve this problem, by taking care of the referencing, organizing, and compiling of patient data to deliver accurate, reliable information in a user-friendly and dynamic format. Pharmacogenetic testing can produce a wealth of information for providers, and with proper organizing and referencing of that data, clinicians can now leverage that information for more accurate and precise prescribing. And software platforms need to be laboratory and electronic health record agnostic so more health plans and health systems can bring the full value of PGx testing insights to more patients to improve treatment and reduce adverse drug reactions and events.
Medicine is rapidly moving toward a model of patient-centered healthcare, and precision prescribing and information management will be integral to a successful rollout. Sooner than later pharmacogenetic testing will be as widely accepted as newborn screening tests and used to tailor more cost-effective and efficient treatments and procedures for every patient. The missing link until now has been the technology to provide pharmacogenetic insights to the clinician so accurate prescribing can occur at any point of care quickly with confidence. In my opinion, it bears repeating: precision prescribing is no longer a trend, it is a necessity for both cost-effective, patient-centered healthcare in 2022 and beyond.
Editor’s Note: Bernard Esquivel is the CMO of GenXys Health Care Systems, a practicing physician-scientist, and international leader with in-depth expertise developing new markets, devising compelling value propositions and go-to-market strategies, and launching programs to fulfill organizational goals and objectives in the healthcare space. Notably, he mobilized a local healthcare community to engage in the practice of precision medicine by founding and presiding over the Latin American Association of Personalized Medicine (ALAMP). This organization now includes more than 500 members from nine countries in Latin America.
[1] https://www.nature.com/articles/news.2008.676