Dr. Chad Bousman is Assistant Professor at the Department of Medical Genetics, Psychiatry, and Philosophy & Pharmacology at the University of Calgary and a member of the Alberta Children’s Hospital Research Institute. The broad vision of his research is to discover, develop, and evaluate genomic-based tools with the utility to guide clinical decision-making and improve mental health outcomes. His primary focus is on optimizing the selection and dosing of drug therapies used to treat depression and schizophrenia. Dr. Bousman is also actively involved in the research examining the interactive effect genes and environments have on the brains of those with mental health problems.
1) You work at the Alberta Children’s Hospital Research Institute at the University of Calgary. Can you tell us about the organization and if precision medicine already plays a big role there?
The Alberta Children’s Hospital Research Institute (ACHRI) supports excellence in research, innovation and knowledge translation to improve the health and well-being of children from pre-conception to adulthood. A multi-disciplinary institute of the University of Calgary, Alberta Health Services and the Alberta Children’s Hospital Foundation, the institute creates new knowledge to change practice and shape policy in ways that improve child health outcomes.
Precision medicine is medical care designed to optimize efficiency or therapeutic benefit for particular groups of patients, especially by using genetic or molecular profiling. The institute pursues precision medicine by assisting in the diagnosis of children with rare diseases and enabling individually-focused treatments, including pharmacogenomics where my lab sits. The importance of this research cannot be overstated. One in four children admitted to the Alberta Children’s Hospital is a patient with a hereditary illness. (i.e. arthritis, cystic fibrosis, sickle cell) The Alberta Children’s Hospital Research Institute is one of a few institutes in Canada which can provide rapid genetic testing of rare illnesses to provide meaningful answers to families and clinicians. We have been designated by the University of Calgary as the Centre for Health Genomics and Bioinformatics. Our researchers can also provide experimental gene therapy for some specific disorders by engineering viruses that carry corrected proteins and reintroduce these cells into the patient through a bone marrow transplant.
More information about ACHRI can be found at: www.research4kids.ucalgary.ca
2) You focus on optimizing drug therapy to treat mental illnesses, especially depression and schizophrenia. Are there big differences using precision medicine in psychiatric care in comparison to other medical disciplines?
Precision medicine encompasses a number of strategies for optimizing medical care and these strategies can differ across medical disciplines. The precision medicine strategy that my research focuses on is pharmacogenetics. Pharmacogenetics uses a person’s genetic information to assist doctors in the selection and dosing of medications. There is substantial overlap in how pharmacogenetics is used in psychiatric care and other medical disciplines. However, disciplines such as psychiatry, neurology, oncology, and cardiology are furthest along in the implementation of pharmacogenetics into clinical practice.
3) The costs of precision medicine seem to be higher than those of more traditional treatments. Is precision medicine also a question of money?
Costs are certainly a key concern when it comes to precision medicine but it is important to differentiate between short-term costs and long-term costs. In the short-term, the costs of delivering precision medicine is often higher than traditional treatment approaches because precision medicine is typically associated with the introduction of new technology or additional testing. However, clinical trials are now demonstrating that these upfront costs are off-set by the long-term cost-savings that precision medicine provides. For example, the cost of ordering a pharmacogenetic test prior to prescribing an antidepressant can range from $100-$500, a significant upfront cost relative to standard prescribing practice. However, this testing can assist doctors in selecting an antidepressant that has a higher probability of working for a particular individual, ultimately saving >$3,500 in direct medical costs over the person’s life.
4) If you compare the use of precision medicine worldwide how well is Canada doing?
The clinical use of precision medicine remains limited around the world. However, Canada along with a number of other countries are at the forefront of the precision medicine revolution. As with any new and bold initiative, precision medicine’s successes in Canada will depend heavily on the resources made available for research and implementation projects.
5) What are the main challenges for precision medicine in the future?
Precision medicine is still early in its evolution and will require local and global collaborations to facilitate its transition into routine care. I think one of the biggest challenges will be redesigning healthcare systems to enable seamless integration of precision medicine into practice. This redesign will include education of healthcare providers and consumers on the use and limitations of precision medicine innovations, improvement of electronic health records, and the development of new treatment and prevention guidelines that are aligned with the precision medicine era.