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Precision Medicine in Canada

by Josh Forsythe, on March 19, 2018

We are excited to attend the upcoming Precision Oncology Experimental Therapeutics (POET) Congress in Calgary, Alberta the first week in April. We will have an opportunity to collaborate with precision medicine luminaries from Canada and around the world on how best to transition novel biomarker research into routine cancer management.

Our upcoming trip to Canada inspired thinking about our neighbors to the North. Famous for a single-payer healthcare system, maple syrup, and ice hockey, how are they faring in the campaign to bring precision medicine to Canadian patients?  

Canada has a lot going for it. With the current administration there exists a desire to bring a “more adaptable, innovative, and affordable health system to all Canadians [1].”  A $3 billion investment in homecare, better prescription drug services, and mental health points in this direction. And as for bringing more innovation to the Canadian healthcare system, Trudeau is actively luring Silicon Valley investors to Canada, and those in the technology and life sciences sectors are attracting the most attention for funding [2]. These investments would be on top of the innovation already taking place at institutions such as the University of Toronto and the Hospital for Sick Children. A robust informatics infrastructure and a fleet of Illumina high throughput sequencers will help to sequence the genomes of up to 10,000 children a year [3].  

What’s more is that although Canada is not the most populous of nations, its inhabitants are ethnically diverse. Among the most industrialized countries in the world, Canada has the highest percentage of foreign born inhabitants. Asia is the largest source of origination, but recently there has been an influx of immigrants from Africa, the Caribbean, and Central and South America. Add to this the already diverse ethnicity represented by Aboriginal peoples, including First Nations, Metis, Inuit, and original European settlers [4]. The implications of this are monumental: previously underrepresented groups could gain a greater understanding of their genetics.

Some would say that Canada’s single-payer healthcare system has some advantages for precision medicine, including reduced administrative burden and more centralized data collection and management. 

Yet others are calling out Canada’s noticeable lack of a high-profile, nationwide precision medicine  initiative. Indeed, some other nations already have these in place.  And even the private sector is getting involved: The Human Longevity Institute plans to sequence the genomes of 1,000,000 people by 2020 [5]

Despite the lack of a high-profile precision medicine initiative, Canada is moving forward with a number of small-mid sized genomic initiatives, which are generating some meaningful and actionable genomic intelligence.

Take for example the initiative launched in 2012 in which the Canadian government funded 17 major projects to ramp up precision medicine. These range from the treatment of epilepsy in children to reduce cognitive decline, to immunotherapy to offer cancer patients more personalized treatments, and to detecting fetal abnormalities using maternal blood [6].  

Another initiative, originating from Genome Canada, acknowledges that advances in sequencing and genomic technologies are actually creating disparity for the Indigenous peoples of Canada. In the study, researchers are building a system to make precision medicine more accessible and one in which Indigenous peoples can oversee their own genetic data and work with providers to interpret and use it in a meaningful way [7].  This particular initiative is one of fifteen recently launched by Genome Canada and the Canadian Institute of Health Research, and several other partners. Collectively, they are investing $255 million to bring precision medicine closer to patients [8].

And did you know that if you are a resident of British Columbia you can walk into select pharmacies and get a DNA test so that the pharmacist can recommend the best pharmaceutical and dose based on your genetic profile?  [9]

All of these initiatives could fall short without the proper infrastructure, yet Canada seems to be investing here as well. The Genomics Cloud is a joint effort between life sciences and technology leaders to provide a platform where researchers can easily store and manage genomic data and collaborate with other researchers [10]. Additionally, a project recently announced by the Terry Fox Cancer Institute will also focus on developing a broad vision for data sharing and collaboration such that precision medicine is more accessible to cancer patients [11].

So while Canada may lack a high-profile genomic initiative, they seem to make up for it with a number of smaller, innovative initiatives that are generating meaningful and actionable results. Who’s to say which is better?  

We don’t pretend to know the answer, but what we do know is this: getting precision medicine to be as routine as a trip to the doctor for a cough or a headache is going to take the right tools, the right strategy, and a lot of collaboration. And we are looking forward to collaborating with our colleagues in Canada to do just that!  

 

Reference List

[1] Anon, (n.d.). » Real Change - Liberal Party of Canada. [online] Available at: https://www.liberal.ca/realchange [Accessed 19 Mar. 2018].

[2] CNBC. (2018). [online] Available at: https://www.cnbc.com/2017/03/02/trudeaus-plan-to-lure-silicon-valley-investors-to-canada.htm [Accessed 19 Mar. 2018].

[3] University of Toronto News. (2018). U of T to sequence genomes of 10,000 people per year: “Information is the new oil,” say University of Toronto scientists. [online] Available at: https://www.utoronto.ca/news/u-t-sequence-genomes-10000-people-year-information-new-oil-say-university-toronto-scientists [Accessed 19 Mar. 2018].

[4] Www12.statcan.gc.ca. (2018). Immigration and Ethnocultural Diversity in Canada. [online] Available at: http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-010-x/99-010-x2011001-eng.cfm [Accessed 19 Mar. 2018].

[5] The Globe and Mail. (2018). As world embraces precision medicine, Canada falls behind. [online] Available at: https://www.theglobeandmail.com/opinion/as-world-embraces-precision-medicine-canada-falls-behind/article32221622/ [Accessed 19 Mar. 2018].

[6] Hospital News. (2018). precision medicine. [online] Available at: http://hospitalnews.com/precision-medicine/ [Accessed 19 Mar. 2018].

[7] The Globe and Mail. (2018). Project aims to narrow ‘precision medicine’ gap for Indigenous peoples in Canada. [online] Available at: https://www.theglobeandmail.com/news/national/project-aims-to-narrow-prescision-medicine-gap-for-indigenous-peoples-in-canada/article37698712/ [Accessed 19 Mar. 2018].

[8] Genomecanada.ca. (2018). [online] Available at: https://www.genomecanada.ca/sites/default/files/2017lsarp_backgrounder_en.pdf [Accessed 19 Mar. 2018].

[9] CBC News. (2018). Test your DNA at a pharmacy? Now you can. [online] Available at: http://www.cbc.ca/news/canada/british-columbia/dna-mydna-test-pharmacy-medication-1.4416467 Accessed 19 Mar. 2018

[10]Genomicscloud.ca. (2018). [online] Available at: https://genomicscloud.ca/wp-content/uploads/2018/02/canadian-genomics-cloud-white-paper.pdf [Accessed 19 Mar. 2018].

[11] Bccancer.bc.ca. (2018). Innovative pilot project launched to accelerate precision medicine in Canada. [online] Available at: http://www.bccancer.bc.ca/about/news-stories/news/2016/the-terry-fox-research-institute-princess-margaret-cancer-centre-and-bc-cancer-agency-launch-innovative-pilot-project-to-a [Accessed 19 Mar. 2018].

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