Dr Tal Zaks at Moderna, the innovative pharmaceutical company, describes how their process takes this information about a patient’s normal genes and information from his/her mutated genes found in his/her cancer and pushes both to the cloud. A bioinformatics algorithmic process in the cloud predicts up to 34 mutations that will help our immune system to be much more effective and launch an attack on cancer. Moderna’s process creates a vaccine that encodes for each of these mutations and loads them onto a single mRNA molecule. Once a cancer vaccine is injected it tells the body to express portions of the mutations so that the immune system will recognize the cancer and not attack normal cells which chemotherapy does. Each personalized vaccine is produced on a just in time basis and usually within a few weeks. The combination of personalized m-RNA cancer vaccines plus immunotherapy with checkpoint inhibitors, such as Keytruda, is a powerful way to destroy cancer cells by activating the immune system.

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The 62 year old patriarch who was at the cottage was very sick. He was admitted to the ICU in a community hospital in cottage country.

It was clear that his health problems were too complex for the small community hospital.

That was a rational assumption.

We and the family agreed that it would be best if he was flown, possibly by Orange, to a large academic teaching hospital for specialized care.

That seemed simple.

But it was not simple.

We were told that the care in the ICU in the small community hospital was the same care that he would get in a large academic hospital.

That information provided was false. So, no transfer.

We were told that he was out of the catchment area for the large academic centres.

So, no transfer.

We were told that all the beds at all the large academic centres which were canvassed by our team were full.

Possibly true.

Some were only taking COVID patients. No one would accept our patient with his specific complex health crisis.

So the big lesson is ” DO NOT GET SICK IN COTTAGE COUNTRY”.   Put that one your fridge.

Raymond Rupert

health system advocate.

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This case conference proved to be magical for the family. Raymond Rupert of RCM Health Consultancy was the facilitator. The 3 specialists were able to explain their viewpoints in plain English. The 3 specialists agreed on a neurosurgical procedure for the patient.

The logic and rationale were explained to the family for the first time. The family was able to understand the implications of the surgery including possible side effects and complications but also to understand the possible benefits. Emphasis on possible.

The team at RCM Health Consultancy is committed to organizing case conferences for our clients in order to give patients and their families the opportunity to contribute to the narrative, to understand the basis for decision making and for RCM to advocate for our client’s rights to access appropriate care.

Raymond Rupert patient advocate & healthcare consultant.

info@rcmhealthconsultancy.com

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Amid the challenges of COVID-19, this week’s awarding of the 2020 Nobel Prize in Medicine to University of Alberta virologist Dr. Michael Houghton could not have been better timed. Exactly when we most need it, the world honours an achievement in research that sets the stage for Canada to play an even larger role in vaccine and therapeutic research, development and production.

On Thursday, Dr. Houghton, along with Harvey Alter and Charles Rice, will be conferred the Nobel for their discovery of the hepatitis C virus (HCV) in 1989. HCV once killed millions and damaged the global blood supply system. As early as 1992, new screening tests had eliminated HCV from the blood supply, and by 1996 overall annual transmission rates had dropped by more than 80 per cent globally. Thanks to therapeutics based on the discovery, HCV is the first chronic viral illness in the world that can be treated and cured.

Building on this transformational discovery, the work of Dr. Houghton and his colleagues continues. His team at the Li Ka Shing Applied Virology Institute has developed an HCV vaccine, currently in late preclinical testing, that has the potential to save millions of lives. Together with a group of other researchers at the University of Alberta, his team is also working on vaccines and therapeutics for other diseases, including COVID-19, Alzheimer’s and Group A streptococcus, as well as new anti-cancer drugs.

It is no accident that the University of Alberta is home to world-leading virology and immunology research, along with Dr. Houghton, who is the first Nobel laureate in medicine working at a Canadian university in nearly 100 years. It is the result of decades of strategic government and industry investment and planning, an effort led by Lorne Tyrrell, another renowned University of Alberta virologist, who is responsible for discovering the first antiviral therapy drug to treat hepatitis B. Dr. Houghton came to the university in 2010 as a Canada Excellence Research Chair to be part of the exceptional research cluster that Dr. Tyrrell had created. With an additional gift from the Li Ka Shing Foundation and a major contribution from the Government of Alberta, the University of Alberta established the Li Ka Shing Institute of Virology in 2010 and the Li Ka Shing Applied Virology Institute in 2013 under Dr. Tyrrell and Dr. Houghton’s leadership.

Investment in science is a long game, with research excellence accruing over decades as talent gathers around exceptional people who have the capacity to make discoveries that can change the world. TheNobel not only recognizes that transformational power of discovery – it can also be leveraged to the great advantage of Alberta and Canada. After William Shockley won the 1956 Nobel Prize in Physics for the discovery of the transistor, he moved to Palo Alto, Calif., and with Fred Terman of Stanford University laid the foundations of Silicon Valley. Here in Canada, Michael Smith’s 1993 Nobel Prize in Chemistry, awarded when he was at the University of British Columbia, helped lay the groundwork for a thriving biotechnology and life-sciences cluster in Vancouver.

Commercialization stemming from Dr. Houghton’s 1989 discovery of HCV in California helped to launch a company employing more than 6,500 people worldwide with an annual revenue stream of US$2-billion. Multinational pharmaceutical company Novartis later acquired it for US$11-billion. With Dr. Houghton’s 2020 Nobel win, Canada has an opportunity to leverage his expertise and reputation into broader economic and social gains. If only one of the seven promising vaccines or therapies in development at the institute succeeds in clinical trials, the economic potential will range from $1-billion to $3-billion. Much more important is the benefit to Canadians. As COVID-19 has taught us, we all know how essential and valuable R&D is and the importance of a made-in-Canada solution.

As we celebrate Dr. Houghton’s Nobel, now is the time for Canada to send a clear message to private investors, funding agencies, and major industry and philanthropic partners from across the world. Canada is an international leader in biotechnology R&D. We are open for business in a quickly expanding biotech sector. We can set a bold vision to speed the development of vaccines and therapeutics from discovery to market. The potential benefit? Millions of lives saved, enormous savings to health care systems, enhanced pandemic readiness and a thriving biomedical industry in Alberta and the rest ofCanada.

Source: Globe & Mail Dec 10 2020

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The problem is that each prescription is a chemistry experiment. No one can predict how a patient with depression, anxiety or a bipolar mood disorder will respond to the medications. Each patient is different. Each patient reacts differently to their medications.

It is time to end the chemistry experiment.

Now a simple genetic test using some cells from inside your mouth can be used to determine how a patient will respond to mental health medications.

The results of the genetic analysis, called pharmacogenomics, provides great intelligence about how to treat the patient.

The results of the tests such as inagene or one ome will tell the prescribing doctor what to avoid and what to use. It is simple.

And the test results will tell the prescribing doctor who is likely to become addicted to opioids and which type of cannabis to use for therapeutic reasons.

So we can stop the chemistry experiments and personalize the use of mental health medications with the use of a simple and modestly priced genetic test.

Tell your doctor about this test and that you don’t want to be involved in a chemistry experiment. Tell your doctor that you want personalized medicine. Or call RCM Health Consultancy and we will arrange for the genetic testing. 647 350 5500.

Raymond Rupert patient advocate and healthcare consultant.

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Arranging for the treating team of doctors to have a conversation about a patient’s case is called a case conference. 

Case conferences can be decisive in helping to make big decisions about both investigations and treatments for patients especially when the patient is complex. 

Unfortunately, case conferences are not used as often as they might be. It is our job at RCM Health Consultancy to encourage participation in case conferences.

When case conferences do occur and when they involve the patient and  family, they can be revelatory in terms of sharing valuable information with the patient and family to assist in making decisions. And it is the patient and the family who have the ultimate say in these decisions. 

The team at RCM Health Consultancy has a track record of organizing case conferences with the treating doctors. This is most useful when there is complexity and some confusion about next steps instead of clarity about how the case should be managed. 

When the details of the case are unpacked within the structure of a case conference, then the treating doctors can quickly move to a harmonized view of the case. 

Our objective in organizing case conferences is the best possible achievable outcome for all our clients.   We encourage our clients to engage in case conferences with the treating doctors in a collaborative manner guided by the team members at RCM Health Consultancy. 

Case Study

Jay was 73 years of age. He was very complex. He had hydrocephalus which is a blockage of the cerebral spinal fluid (CSF) flow in the brain. This blockage causes neurologic complications and a tendency to fall. He also has early and progressive dementia.  The biggest risk was the risk of falling. He had 3 super specialists ( 2 neurologists and one neurosurgeon) involved. They had never spoken together about the case until we had organized a case conference. The outcome of the case conference was the decision to stent and fix the hydrocephalus to  reduce the risk of falling. Jay’s wife participated. We recorded the call for her. She and Jay were able to finally make a decision. The family appreciated the support from the team at RCM. 

Conclusion:

The case conference is proving to be an essential process for our clients. The case conference assists the treating team of doctors and the patient and family at achieving clarity about a definitive care plan. Once the definitive care plan is articulated, then the team at RCM assists in implementing the plan for our clients.

Raymond Rupert patient advocate

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