This is especially important for medications used for depression, anxiety, mood disorders and other mental health concerns.

The smart approach is called targeted or personalized prescribing. The question is how does a doctor get the information to do the targeting or personalized prescribing.

The information should be based on the patient’s genes. It is an analysis of his/her genes that provides this information. A saliva test is all that is required. The report provided by a credible genetics lab, such as Inagene in Toronto or Personalized Prescribing, contains all the information that the doctor needs to do personalized prescribing.

The report from the genetics lab tells the doctors which medications to use and which to avoid. It also tells the doctor about dosing the medications. And which other medications of substances such as cannabis will interfere with the prescribed medication.

Everyone metabolizes medications in different ways. Some patients are rapid metabolizers and require higher doses. Some patients are slow metabolizers and require lower doses.

The tests are easy to organize. Go to the lab’s web site. Register. Get a kit. Collect a saliva specimen. Submit the specimen by mail. And the result will be a comprehensive analysis of your genes as they relate to medications. Send a copy of the report to your doctor.

Case Study:

Betsy was 33 years of age. She had gotten increasing sad over the last year or so. She was also anxious. She went to her family doctor. The family doctor prescribed an antidepressant that worked for a while but then stopped working. The family doctor wanted to switch Betsy to another antidepressant. She took the new antidepressant and stopped the first antidepressant cold turkey. That was a mistake. It should have been tapered slowly. This resulted in Betsy becoming ill as she withdrew from the first antidepressant and got a full dose of the second antidepressant.

Betsy’s enlightened friend who is also a doctor suggested the inagene test. The results showed that Betsy had a number of gene mutations including the CYP2C19 gene variant. The inagene report suggested that the doctor use another antidepressant. And if this specific antidepressant was used that the doctor should consider a 50% dose reduction.

Her family doctor was not interested in the genetics report. However, Betsy had been referred to a young psychiatrist who was totally up to date on the science and understood how to interpret the genetics report, how to select the correct antidepressant and how to dose the medication based on the patient’s genetic report.

Summary:

Prescribing medications is usually an experiment that might fail. Now with genetic testing of patients, doctors can have the information that helps them and the patients by helping with the selection of the right medication and then by helping with the decision about dosing.

The key for patients is to find a doctor who understands or is willing to learn how to use personalized or targeted prescribing based on the patient’s own genetic information.

Keep well. Be safe.

Raymond Rupert, patient advocate and healthcare consultant.

The post How ToPrescribe The Right Meds Without Experimenting. Raymond Rupert patient advocate appeared first on Raymond Rupert.

And from a piece in the New York times today on the role of government in solving massive social problems. The private sector can’t do that without some involvement of government. It is synergistic with the private sector and government working together.

An example of this is the new Pfizer coronavirus vaccine. The US government created the Warp Speed Project and put in an advance order of US$1.95B for Pfizer vaccine. This gave Pfizer the initiative to commit dollars to research and development of the vaccine. The combination of government and private sector lead to this extraordinary success.

Here’s the problem that we have in Canada. Advanced cancer drugs and drugs for rare diseases are very expensive. Some are hundreds of thousands of dollars per patient per year. Doctors are hesitant to prescribe them. Patients miss out on the opportunity to use them. And private insurers of drug plans are, in many cases, not paying for them.

So we need a solution. This requires a creative process to generate a unique solution. And a creative solution is usually the result of a new combination that solves the problem and creates value for all the parties involved.

The real problem is the inertia that this creative solution will meet in the real world. Unless, for some unknown reason, this idea gains traction and results in an actionable plan by both government and the private sector. Activists might play a role in this process.

Here is how this plays out.

R.D. was 65 years of age. He was diagnosed with pancreatic cancer in March 2020. He had a surgical procedure called a Whipple. This removed the entire pancreas. He had a very skillful surgeon who was able to secure operating room time during the COVID lockdown. Not a trivial matter.

The pathology showed that there was micro-vascular spread. So chemotherapy started. It was challenging for R.D. Then he had targeted radiation.

R.D. asked the team at RCM Health Consultancy to organize genetic testing of his cancer. We sent tissue to a special lab for molecular profiling. This was paid for privately. The results came back showing that he would benefit from Olaparib. This is called targeted therapy. The drug targets the mutations in the DNA of his cancer. This is the approach taken at world class cancer centres like M.D. Anderson, Memorial Sloan Kettering and Dana Farber. Some cancer centres in Canada have a limited programme of this kind.

R.D. had an insurance plan that paid for prescriptions. His medical doctor wrote the script for Olaparib. And the insurance company reviewed this request and wrote back that they were going to take 9 months to review the request. That was improper. It was a breach of his contract with the insurer.

When you look at the economics of drug plans from the insurer’s perspective, it is clear. They have to conserve capital to stay solvent. They have not reserved properly to pay for these advanced cancer drugs.

So here is where the government enters the picture to solve this massive societal problem.

Dr Eric Hoskins transitioned from the Ontario government to the Federal government to introduce pharmacare for all. That did not happen.

So, for Dr Eric Hoskins and his team at the Federal government, here is a more likely playbook. The government could provide a backstop for the private insurers. This is called reinsurance.

For example, if the drug claim to the primary insurer is over $30,000, then the claim would be sent to the government for payment. Anything less than $30,000 would be paid by the primary insurer. Only a government has the deep pockets required to pay for these expensive drugs.

This would be a form of pharmacare for catastrophic drug costs. This would be an excellent example of the government working with private industry to solve a massive societal problem.

So here’s the challenge for the private sector and government to start to talk about moving in this direction before R.D. initiates his class action legal action and involves thousands of other patients and their families in this effort to fund advanced cancer drugs.

Catastrophic pharmacare can only occur if government and the private sector work together.

I invite those interested in this matter to join the converation.

Raymond Rupert patient advocate and healthcare consultant.

The post Solving The Funding Problem For Advanced Cancer Drugs: Raymond Rupert patient advocate appeared first on Raymond Rupert.