Illustration by Myriam Wares
Burns Blaxall’s department at The Christ Hospital is a relatively nascent one—but its work has the potential to touch every corner of medicine. As the hospital’s executive director of precision medicine, Blaxall knows the work of his team could completely transform the way we think about healthcare, from who gets screened for what and when to which medicines we take. “I get out of bed in the morning because I’m passionate about what I do,” he says. “And I want to make a difference.”
Using genetic data obtained through procedures as simple as a cheek swab or a blood draw, doctors in Blaxall’s field of pharmacogenomics hope to make an industry-wide mindset shift from reactive to proactive, personalizing screenings and treatment for each individual patient.
It’s a shift many patients need now more than ever. More than 50 million people in the U.S. alone take more than five medications per day. But recent research suggests that as many as 99 percent of people have one or more DNA mutation that would affect the way those drugs are processed in the body.
And that leads to mounting expenses. In 2018 alone, Blaxall notes, the estimated cost of non-optimized medication totaled over $500 billion. “It’s just absolutely remarkable,” he says. “And it turns out that there are at least 23 genes that impact how we process medicine.”
It’s common for patients prescribed antidepressants, for instance, to try two or three medications before finding one that works for them—and that’s in part, Blaxall says, because the most common mutation in DNA that impacts how drugs are processed is the one that affects the largest class of antidepressants.
What if you tested for that mutation before prescribing an antidepressant? “Now,” Blaxall says. “Imagine the patient who’s taking five medications, or 10 medications, or more.” Not only could this kind of personalization save a considerable amount of time, money, and suffering—it also has the potential to save lives.
Blaxall sits on the Clinical Pharmacogenomics Implementation Consortium, which provides guidance on when to do genetic testing before prescribing. Under his direction, advances in precision medicine are already taking shape and changing the way The Christ Hospital cares for patients. The hospital recently embedded seven pharmacogenomics-certified pharmacists into its primary care physician offices and introduced a new AI tool that lives in patients’ medical records, alerting doctors and pharmacists if an adverse reaction is likely.
“In hospital systems across the United States, well over 30 percent of patients—because of the medications they’re taking alone—have a higher risk of ER visit or hospitalization than if they were to have heart failure, kidney failure, diabetes with complications, atrial fibrillation, etc.,” Blaxall says.
So far, the numbers are promising. Preliminary data suggests that by implementing comprehensive precision medicine and genetic testing, the U.S. could reduce ER visits, hospitalizations, and health resource utilization by anywhere from 20 to 40 percent.
Thanks to recent advances in technology and understanding, the resources are increasingly in reach. At The Christ Hospital, a comprehensive pharmacogenomics screening costs $250. And DNA doesn’t change—so those results are locked. “That is your lifetime,” Blaxall says. “For me, this is the lowest hanging fruit of how we can improve medication today.”
Executive Director, The Christ Hospital Precision Medicine
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