News and Features
Drug Testing to Save Lives
By Roberta Staley published Mar 1, 2010
5,400 Canadian children die each year from adverse drug reactions. Two Vancouver researchers are fighting for genetic testing that could save them
When, just 12 days after his birth, Tariq Jamieson died suddenly in Toronto, the coroner was puzzled. He suspected the cause to be Sudden Infant Death Syndrome but ordered laboratory tests to be sure. The test results solved the puzzle but deepened the mystery: Tariq Jamieson had died of a morphine overdose.
But how? The infant had not been administered any painkillers. With no clues in the outside world, the investigation turned inward. A sample of Tariq’s mother’s blood was sent for testing. Technicians scrutinized her genes, using a process called genotyping, which involves looking for polymorphisms, or variations, among the genes responsible for drug metabolism. The mystery, finally, was resolved. The mother was the inadvertent killer of her baby. Or rather, her genes were.
All cells in the human body contain two sets of identical genes, the twin serving as backup in case one gene is damaged. (Humans have about 30,000 genes scattered irregularly along 23 pairs of chromosomes, an inheritance bequeathed by both parents.) In the case of codeine, humans normally have a single gene (plus its twin) that transforms it into morphine. Tariq Jamieson’s mother, however, had two genes (each with a twin) working to turn the narcotic into morphine. Four genes, rather than two, were instructing the body to manufacture morphine, turning breast milk into poison.
The Jamieson case was presented in a paper that appeared in Nature Publishing Group. It was co-authored by two Vancouver doctors, physician Michael Hayden and pediatric clinical pharmacologist Bruce Carleton, the principal investigators in the Canadian Pharmacogenomic Network for Drug Safety. (The study of the influence of genetic variation on drug toxicity and efficacy is called pharmacogenomics.) This network of physicians and clinicians across the country collates reports and initiates studies into adverse drug reactions, seeking to determine which genes are linked to the sometimes debilitating or even lethal effect of medications. It was thanks to the work of Hayden, Carleton, and several others that the extra copies of the gene responsible for excess morphine production, CYP2D6, were identified. A worldwide warning about the possible danger of using codeine while breastfeeding was circulated in late 2008, saving probably thousands of babies every year from a coroner’s scribbled “SIDS.”
That discovery was part of a larger, more sublime goal that Hayden and Carleton set themselves: before a physician prescribes a drug, they want to see an inexpensive genetic test ordered to ensure that the patient doesn’t harbour polymorphisms that turn good medicine bad. Called predictive diagnostics, this approach foretells a kinder, gentler medicine, in which drugs are prescribed based on a patient’s unique genetic makeup rather than the generalized regimens currently given to patients with ailments like cancer, heart disease, and psychiatric illness. “It’s moving back to the roots of medical care,” says Carleton. “It’s about what this individual patient needs, not what health professionals think he or she needs.”
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i appreciate the initiative taken by them but would actually advice the doctors to spread every detail to the parents before taken any step while pregnancy and even the parents to consult a trained and sound practitioner before taking any such step which may lead to serious harms.
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Physicians are dealing with the need to protect people with sensitivities the way they dealt with the need to wash their hands when they were first told about it. Read Oliver Wendell Holmes or Ignaz Semmelweis. Canada Vigilance is invisibilizing work Health and Welfare did prior to the 1993 election to reduce preventable harm being caused to persons with sensitivities.
There are a number of contributing factors. The main one is that health authorities are eclipsing the history of persons with sensitivities behind a legltimate but separate debate about the flaky ideas of so-called "doctors of environmental medicine."
If the ongoing abuse of patients with sensitivities is going to be stopped, authorities, including public servants and various agencies of remedy, will have to implicitly acknowledge that they have contributed to attitudes that result in the kind of treatment your child was subjected to. In my experience with Ottawa and Toronto, it is something public servants do not like to do. In fact, if you go by what officials at Health Canada and the Ontario Ministry of Health have done, public officials will casually kill children if doing so is necessary to covering up their mistakes and bigotry. See http://ages.ca for documentation, including a list of mistakes and consequences.
As mentioned, people in BC are jeopardized by the hostility of your medical officer of health, Perry Kendall, who was a serious problem on the issue when he was with the Ontario Ministry of Health. Recent communication indicates his attitude has not changed.
Sorry miss read new to posting above is a reply to Chris Brown. I don't normally respond but I couldn't let this one go.
I am replying to the comment by "Discussed-Encouraging other ideas is irresponsible, and only serves to hide the fact that Canada Vigilance and other groups know there is an existing, publicly insured method of diagnosing sensitivities and protecting patients"
I would like to know if there is an existing, publicly insured method of protecting patients how come I just spent a nightmare of a year trying to convince the medical system that my teen was not having a temper-tantrum and had to safely wean her off a medication myself, after being abandon by our local medical system who told me not to bother coming back. We found out recently from an out of town medical system that she was experiencing non epileptic seizures. Once the medications were out of her system she has not experienced them. She, prior to this, was having the seizures on a daily bases and sometimes twice a day and rolling in,out and back in for up to three hours strait. We had over 60 911 calls last year and most of them leading to the Emergency Department at our local Hospital. Where was the so called existing protection for Patients?
Scientists continue to bilk the public purse and help to invisibilize wanton irresponsibility in health authorities by pretending that adverse reactions are caused by a single condition that can be identified by a marker. As Health and Welfare pointed out to the provinces in the late 1980’s, sensitivity is caused by a compendium of diseases, deficiencies, injuries and naturally occurring anomalies. Encouraging other ideas is irresponsible, and only serves to hide the fact that Canada Vigilance and other groups know there is an existing, publicly insured method of diagnosing sensitivities and protecting patients rather than counting the injured and killed. The method was identified in a 1985 Ontario Ministry of Health report and it is encouraged by the College of Family Physicians of Ontario. It’s use, by seniors, has been encouraged by the Manitoba Human Rights Commission. BC is in a bad spot because of the irresponsibly hostile attitude of your Medical Officer of Health, Perry Kendall. Pretending that reducing adverse drug reactions is dependent on future science is irresponsible and dangerous.
