Last week we announced Dr. Bernard Esquivel as our Chief Medical Officer. This summer our Board Advisor Ohad Arazi sat down with him to discuss the accelerating adoption of precision prescribing. In this conversation, they discussed Bernard’s passion for precision health and why he’s so excited to be a part of our team. They also discussed what milestones need to be achieved for precision medicine to become an integrated part of standard health care.

Accelerating Adoption of Precision Prescribing: A Conversation with Dr. Bernard Esquivel

Accelerating Adoption of Precision Prescribing: A Conversation with Dr. Bernard Esquivel

Earlier this year, I decided to take the plunge and join the board of GenXys Health Care Systems (GenXys) as an independent board member. I have been intrigued by precision medicine for years, wondering why this has been historically slow to catch on. In a world where we hyper-personalize everything, where our daily coffee is prepared to our personal taste and preferences with 100% accuracy or we send it back, it is difficult to fathom that when it comes to healthcare we often get just a basic cup of coffee. In fact, when we are prescribed a drug therapy, there is only have a 50/50 chance as to whether it’s going to work or not, given the unique genetic and metabolic makeup of each of us, our family history and many other factors. The implications of these inefficiencies in our prescribing process are monumental – Adverse Drug Reactions (ADRs) are 4th largest cause of death in the US, costing taxpayers approximately $130b annually.

The reality is that to get an accurate prescription takes a lot of thinking and numerous complex variables which cannot be assessed in a seven-to- ten-minute consultation, which is the average amount we spend in a typical session with our family physicians.

As you’d expect, the amount of data required to identify safe and effective drug options for an individual patient increases dramatically for each condition that they have. For example, treating a condition in a patient who also has depression and Type 2 diabetes requires the evaluation of several hundred data points. These pieces of information are held in multiple different sources including a drug-drug interaction database, an electronic textbook, guidelines, systematic reviews of evidence, and drug monographs. Even if you look at just one drug and check whether it needs adjustment for kidney, liver, other conditions, and other drugs it takes more than a couple of minutes. This issue is further amplified for patients with chronic diseases that are taking three or more medications daily – a cohort that makes up 20% of all Canadians.

This challenge is what attracted me to work with GenXys – a company that is profoundly committed to removing trial & error in the prescribing process, through the use of real-time, clinical decision support tools, that are informed by pharmacogenetics. I knew this was going to be a roller-coaster, given the amount of education and change management that lay ahead of us, but I was encouraged by the company’s traction in bringing in high quality institutional investors and launching transformative programs, like the mental health program with Green Shield Canada. My confidence in GenXys has recently redoubled, with our most recent talent acquisition, Dr. Bernard Esquivel, joining the company as Chief Medical Officer.

Bernard brings to the table a rich experience in many of GenXys domains – from genomics and precision medicine to population health management. Bernard has also been on a mission to make precision prescribing a reality, overcoming numerous challenges to bring genetic insights to the point of care as a physician executive in Mexico, the US, Europe and now Canada. I had that opportunity to spend some time with Bernard this week, hearing about his unique journey. Here’s a synopsis of our my questions and our conversation.

Q: What first attracted you to precision health?


During the last years of my medical training, I had the privilege of being deeply immersed in the close interaction of the immune system and our genetic information. That’s when I started understanding the intricate systems interaction that happens in a single individual. The next milestone was quite disruptive: it became clear that we currently practice mostly reactive medicine. Diagnosis-treatment and newer approaches have appeared, and even been implemented in the clinical scenario as pre-emptive, and now with the power that Artificial intelligence and Machine learning bring into the table, predictive medicine. Predictive medicine, in other words, analyzes several datasets of a single individual and, using mathematical modelling, predicts how a patient may respond to treatment or what is the risk of developing a disease. This provides information that allows implementation of preventive measures to avoid or delay the onset of diseases or complications related with the conditions or treatments. Long story short, utilizing the patient’s DNA makeup opened a whole new healthcare era that immediately pulled me in:  a one-patient, one-plan. 

Q: This is such a big field – why prescribing and why GenXys?


Medications and treatments are tested on large populations and are prescribed using statistical averages. As you correctly pointed out before, on average, any given prescription only works for half of those who take it. Therefore, they work for some patients but not many others, often due to genetic differences. Nevertheless, genetic information is just another piece of the puzzle. Many other relevant factors must be considered prior to prescribe, such as weight, height, age, gender, kidney function, liver function, additional diagnosis and comorbidities, drug-drug interaction, social determinants of health, just to mention a few. A holistic comprehensive, clinically driven and science-backed integration of the factors enlisted before is the value proposition of GenXys: this is why I am excited to be part of this fascinating and disruptive team.

Q: Why is it so hard to make this part of the standard of care?


It is hard, but it is the normal pathway of new concepts within healthcare: it needs to go through a long but necessary process before being considered part of the standard of care. Some of the milestones that need to be achieved in order to get there are clinical validity, clinical utility, clinical actionability, cost-effectiveness, training and education, and smooth, user-friendly integration into the day-to-day ecosystem.

Q: What differentiates a leader in this new precision prescribing field?


Precision medicine is an exciting field with the outstanding characteristic of bringing several areas of knowledge beyond medicine together. I firmly believe that a good leader needs to be eager to continuously learn with a broader scope, covering at least the regulatory landscape, always backing up products and value propositions on an evidence-based approach and clinical actionability. And most importantly, never forgetting that patient comes first.

Q: You’ve had such an interesting personal journey with pharmacogenetics from Mexico to the US and now to Canada – what are some of the common threads that you see? 


Every health care ecosystem is unique and has its synergies and challenges, but I have encountered three constants, independent of the geographical region: 1) awareness/ education from the healthcare providers, 2) reimbursement/ coverage gaps, and 3) implementation complexity.

This has come to light across my journey from Mexico to Canada, through the US. After finishing my studies, I started my private practice in Mexico City, keeping in mind a personalized medicine approach for my patients. That is when I noticed a big gap; no one was broadly offering genetic testing solutions. So I reached out to friends in the US in order to get access to tools such as exome sequencing, pharmacogenomics, etc., and faced my second problem: the import-export piece of biological samples. After finding a way to navigate it, I finally started using genomic testing in my practice. Slowly, other colleagues approached and requested my support to begin implementing a genomic practice as well, from the training educational piece- to the logistics and financials around it. That is when I decided to start my company. After five years, it became one of the largest genetic companies in Latin America, having 85 country distributors and operating in Guatemala, Chile, Ecuador, and Argentina.

Years later, I received several invitations to share our implementational experience and actively engage at the Mayo Clinic Individualized Medicine Conference and got immersed in the US precision medicine ecosystem on several fronts, from the research as a founding member of the Pharmacogenomics Research Network,  academic as senior editor for the NIH-NCBI genetic summaries, industry serving as Chief Medical Officer for  biotech organizations, field advocate via numerous initiatives such as STRIPE, Precision Medicine Advisors, etc.  Life is about balance, and when my family and I visited Vancouver four years ago, we fell in love immediately. And after discovering that it is a vibrant, growing hub for life sciences innovation, we made the call and move into Canada, starting a new chapter in our journey.

I can’t wait to begin spending time with our customers and our partners, and getting to know the incredible team that has taken the company this far. I’m confident that this is going to be a very exciting ride. Let’s get going!

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