Amani Saini holds a Master of Public Administration degree from Dalhousie University and bachelor’s degree in Political Science from the University of British Columbia (UBC). Science was never her forte and she tried her best to avoid science classes, but the near death of her sister forced her to start searching for solutions to prevent adverse drug reactions. After she came across an article about genomics, a topic she knew absolutely nothing about before, she contacted scientists in Canada and worldwide to learn more about the discipline and DNA sequencing. She took her findings to scientists and pharmacists at UBC and found that there is a solution to adverse drug reactions that could be potentially feasible in Canada, which she has been advocating for since.

“A few years ago, while studying for her mid-terms, my then 19-year-old sister took an Advil Cold and Sinus pill which was given to her by a doctor at UBC Student Health Services for her common cold and had an allergic reaction. She was diagnosed with toxic epidermal necrolysis, a life-threatening condition and spent about three weeks at Vancouver General Hospital fighting for her life in the intensive care unit. We were told that there was no possible way she would make it, but miraculously she did! After-wards I learned that adverse drug reactions are common and thousands of Canadians have died from them and I thus started searching for solutions to prevent them from happening. Through my research I learned about genomics and personalized/precision medicine. I hope one day no Canadian will have to suffer from an adverse drug reaction. This proposal is what I envision for the country.”

An adverse drug reaction (ADR) is a noxious unintended consequence of taking a normal dosage of a drug,1 usually prescribed to an individual by a medical professional, that was properly administered and which was supposed to be beneficial for the patient towards curing a disease or sickness. A sick patient, anyone ranging from a child with the common cold visiting their pediatrician to an adult patient with a severe form of cancer in the intensive care unit, may be given a medication to take which they nor the administrator of the medication is aware that they are allergic to and their body will respond negatively to that drug. A 2013 Canadian Institute of Health Information report stated that between 2010 and 2011 more than 27,000 Canadians aged 65 and older suffered from an ADR.2 The consequences of an ADR may include damage to the proper functioning of a patient’s body internally and/or externally, prolonged hospitalization, significant disability/incapacity, life-threatening injuries, congenital anomaly and even death.3

Costs associated with ADRs significantly add to health care expenditures in an era where health care spending already eats up roughly 50% of the annual budget in some provinces. In a 2011 study which examined 1,000 patients admitted to the emergency department at Vancouver General Hospital, 122 or 12.2% were in the department due to an adverse drug event. Of these patients, 48 were present because of an ADR (one type of adverse drug event defined as an unintended response that occurred despite use of an appropriate drug dosage). After adjustment, patients with adverse drug events had a higher risk of spending additional days in the hospital per month (6.3% versus 3.4%) and higher rate of outpatient health care encounters (1.73 versus 1.22), and the adjusted median monthly cost of care was 1.90 times higher (Can $325 versus $96).4 It was estimated that the added cost could be as much as $49 million annually.5 These financial costs are in addition to the physical and psychological costs endured by ADR patients. Furthermore, the number of deaths resulting from ADRs is staggering. In Canada, they cause 10,000 to 22,000 deaths and cost the Canadian healthcare system over $13 billion per year.6 In the United States, another developed country, 26,500 children die from ADRs each year.7

Until just recently, there was little, if not anything, that could be set in place to prevent ADRs and thus Canadian governments have not taken direct action on preventing ADRs. However, recent scientific advancements in the past decade have produced concrete evidence to demonstrate that ADRs can be prevented by making use of genomics.

Every individual is made up of various genes, which are inherited from their parents and determine the traits they will develop, from whether they will have curly or straight hair, to how they will respond to certain medications. When some genetic variants in a cluster of immunity genes combine with certain medications, they can produce a negative reaction, an ADR.8 Scientists in several jurisdictions, including Asia, Europe and the USA have identified destructive drug-gene combinations.9

Today, technology has developed to the point that a simple test can be conducted which extracts DNA and sequences it to determine which genes and which gene variants an individual possesses. Here at home, in British Columbia, researchers are looking to introduce a genetic test to guide prescription practices by family doctors for patients who are over 65.10 This research is being funded through the National Research Council and Genome BC, both of which are government organizations.11

The identification of harmful drug-gene combinations means that some ADRs can be entirely prevented. For example, it was discovered that the gene variant HLA-B*15:02 combined with the drug carbamazepine resulted in the allergic reaction toxic epidermal necrolysis (TEN) and Steven Johnson’s Syndrome (SJS), the less severe form of TEN.12 When Taiwan identified patients carrying the HLA-B*15:02 gene and had them avoid carbamazepine, it saw a significant reduction in SJS-TEN, preventing an estimated ten cases of these potentially life-threatening diseases.13

In 2010, Taiwan, realizing the benefits associated with conducting genetic tests versus the costs of caring for SJS-TEN patients, began covering the cost of genetic tests as part of their national health insurance.14 This action towards preventing ADRs can be taken towards high frequencies of ADR related genes in Canada and/or all drug-gene combinations that have thus far been successfully identified.

Canadians should be tested to determine which gene variants they carry and if they carry a variant that could result in a negative reaction to a drug, then that trigger drug should be withheld. Thousands of lives could be saved and savings would be in the billions for Canada. Governments could give their citizens the option of having a genetic test; through the same manner in which patients receive blood tests today in each respective province. It will not be feasible to have 35 million Canadians tested at once and as health care is provincial jurisdiction, each province will differ in its approach and in prioritizing segments of their population. We must start somewhere and there are various population starting points jurisdictions could take:

OPTION 1: Patients. As a patient is prescribed a new drug by a family doctor or anywhere in the health care system which they have never taken before, they should be given the option of taking a genetic test to determine which gene variants they carry and this knowledge should be used to guide the prescription of drugs.

OPTION 2: Children born into a Canadian hospital. Parents should be asked if they would like to have their newborn tested and told about the consequences of ADRs. This would be a favourable stream to target as the child is already present in a health care facility, so this would reduce the future cost associated with visiting a family doctor and laboratory appointment. This would make the individual (and guardian) responsible for their own health and measures can be taken to ensure that they never suffer from an ADR from the time of birth to death.

The governments of the U.S. and the U.K. have already shown incredible support for the increased use of genomics to guide health decisions. In 2015, President Obama announced $215 million to fund the creation of a national research program to sequence DNA to identify the genetic drivers of diseases.15 In order to continue to be a world leader in health and technology, the Canadian government should take on a similar national approach. Provincial jurisdiction over health makes it acceptable for provinces to act solely on health related initiatives. However, to effectively identify harmful drug-gene combinations, provinces need to work together to pool together their genetic information to explore correlations. Therefore, leadership from the federal government which fosters collaboration and brings together provinces and necessary partners would be conducive to detecting harmful drug-gene combinations.

Additionally, the federal government should reach out to international colleagues engaged in this pursuit. To identify the genetic variants for rare diseases, a larger sample size is required and therefore one country or even continent cannot combat rare diseases on its own and global cooperation is mandatory.