Week 9: Personalized Health Care and Pharmacogenomics. An exciting innovation in health-care or a dangerous tool?

The focus of this week's discussion in my health informatics class is electronic health technologies in clinical practice settings. The concepts of personalized medicine and pharmogeconomics were discussed. 

I researched the definitions of each concept (personalized medicine, pharmacogentics, and pharmacogenomics), to further enhance my understanding of the concepts after the class discussion. 

Definitions : 

"Personalized medicine refers to the delivery of health care based on the individual uniqueness of the person. It utilizes individual's genetic and genomic information to make medical decisions about their care..." (Chadwell, 2013, pg. 1) 

 Pharmacogenetics is defined as ‘‘the study of inherited differences in drug metabolism and response’’. (Chadwell, 2013, pg. 1) 

 Pharmacogenomics as known as ‘‘the general study of all the many different genes that determine drug behavior" (Chadwell, 2013, pg. 1) 

Throughout the class discussion both the possible benefits and consequences of personalized medicine were discussed. I created a list of benefits and consequences to organize the information . 

  Benefits of Personalized Medicine: 

• improves the ability to diagnose and predict disease (Chadwell, 2013)
• contributes to providing interventions earlier in the course of diseases (Chadwell, 2013)
• may lead to the development of  customized and personalized prescriptions (Issa, 2007)
• improves patient compliance (Issa, 2007)
• reduces or completely eliminates the  costs related to disease management (Issa, 2007) 
• supports a client-centered care (Chadwell, 2013) 

Consequences/ challenges of personalized medicine: 

• genetic discrimination 
• issues in ensuring equitable access to genomic technologies (Issa, 2007) 
• issues in ensuring privacy and confidentiality of genetic information (Issa, 2007) 
• issues related to the use of genetic information by insurance companies and employers (Issa, 2007) 
• psychological impact of knowing genetic information (Issa, 2007) 
• the possibility of social stigmatization for patients based on their genetic information (Issa, 2007) 

Genetic discrimination in Canada 

Through the class discussion,I become interested in the issue of genetic discrimination in Canada and I decided to further explore the topic. 

In Canada, there are some regulations that indirectly inform the issue of genetic discrimination. For example, it is a right under the Canadian Charter of Human Rights and Freedoms that addresses the right to equality and to not be subjected to discrimination (CCGF,2009). However, there are NO legal documents that specifically address and prohibit genetic discrimination (CCGF, 2009). Furthermore, Canadian laws permit insurance companies to have requirements related to providing health information and this information can be used to determine eligibility for insurance and to set premiums ( CCGF, 2009). In addition, insurers can ask clients about their genetic information, family history, and must consent to have their information verified (CCGF, 2009). 

After exploring the laws and regulations around genetic discrimination in Canada, I was left with the following questions: 

 How might genetic discrimination impact people's social determinants of health? How does genetic discrimination ultimately impact people's health?  

In nursing it is important to consider the social determinants of health when assessing clients, and to provide holistic care. Genetic discrimination has the ability to impact a person's social determinants; therefore, it is an important issue for nurses to consider. Genetic discrimination by employers and insurance companies can lead to unemployment and low socio-economic status. In addition, the fear of genetic discrimination from employers and insurance companies may prevent people from participating in genetic testing (CCGF, 2009). Genetic testing benefits individuals by empowering them to be proactive about their health, plan of their future, and make important life decisions (CCGF, 2009); therefore, if people are too afraid to get tested they will not get the benefits. 

In reflection

In the overview for this weeks class we we're asked to reflect on the following questions: 

What are your beliefs about personalized medicine, or, genomic investigations related to your DNA sequencing? Would you want to know if you had a massive predisposition to illness or a specific medical condition? 

Through the information that I have gathered from the class discussion and researching personalized medicine, I feel that the benefits of personalized medicine outweigh the possible consequences. Although, I feel strongly that  a personalized medicine approach should not be integrated into the Canadian health-care system until Canada creates laws that protects its citizens from genetic discrimination. 

References

Chadwell, K. (2013). Clinical practice on the horizon: Personalized medicine. Clinical Nurse Specialist, 

      27(1), 36-43. doi: 10.1097/NUR.0b013e31827770301000-00010

Issa, A. M. (2007). Personalized medicine and the practice of medicine in the 21st century. McGill Journal 

     of   Medicine, 10(1), 53–7. Retrieved from http://www.med.mcgill.ca/mjm/  

N.A. (2009). About genetic discrimination. Retrieved from the Canadian Coalition for Genetic Fairness          website: http://www.ccgf-cceg.ca/en/about-genetic-discrimination