The Minister of Economy and Innovation, Pierre Fitzgibbon, announced sums of some $ 40 million to promote the emergence of university and private initiatives in personalized medicine in Quebec.
While this approach has been in the medical arsenal for years, mainly in oncology, it is difficult to fit into Quebec, which is plagued by chronic restrictions on the development of the health system. And since COVID-19 has invited itself into our lives, it has also undermined most of the resources of hospitals and has won, if not enthroned, as an axis of development for two years. COVID-19 therefore accentuates delays that were already present.
In oncology, the lack of development in diagnostic capacity and approval of innovative therapies is glaring. Quebec suffers from a significant delay in identifying characteristics of tumors or patients that open the door to more effective and generally less toxic targeted therapies. No test, no adapted, personalized treatment. The relationship is direct.
As the saying goes, and it is even more true when it comes to the application of medical knowledge, which does not move forward retreats. This is the feeling of many Quebec physicians who have lost the feeling of offering the best of what science could offer.
It has been proven by numerous studies that patients have better survival when they take advantage of tests to personalize their treatment. We must act on such findings.
Personalized medicine is expensive
While the notion of the primacy of science has encompassed public discourse since COVID-19 emerged and social restrictions were imposed secondarily, it has been neglected for many areas of Quebec medicine other than healthcare. patients with COVID-19.
Because personalized medicine is expensive. We are moving away from the concept of ONE treatment that offers a benefit for the MAJORITY of patients, to those treatments that are most likely to be effective for EVERY patient.
Identifying the peculiarities of each tumor requires diagnostic efforts in molecular biology to find abnormal genes, to understand the link between the expression of various genes, to predict and follow the heterogeneity of cancer cells during disease.
Change calls for new paradigms. Medicine and health authorities have based the acceptance of new therapies on phase III, comparative studies involving multitudes of patients with the same pathology. In the context of personalized medicine, large groups disappear. Each individual has their own genetic characteristics and each cancer is distinguished from another by its specific gene expression.
It then becomes more difficult, if not sometimes impossible, to conduct phase III studies requiring the inclusion of multiple participants in order to obtain sufficient statistical proof.
What do we do then?
We must sometimes accept less important proof, because the expected benefit seems to be so significant that depriving a sick individual of it goes against the most basic notions of morality. But we must also force ourselves to list all the patients who have similar conditions and to review, after the fact, whether the decisions taken were the right ones.
Thus, personalized medicine, to be effective, requires, strangely enough, to be able to refer to collective experience. And in this regard, Quebec is also a poor student, with incomplete data and a lack of cohesion to accumulate relevant data.
Admission made by the Minister of Health, Christian Dubé, with his intention to promote the circulation and interpretation of data.
Excellence
In November 2021, Statistics Canada released its annual cancer report. We learned that 43% of the population will be diagnosed with cancer during their lifetime and that 25% will die from this pathology. But Quebec knows very little what happens to its cancer patients. This report indicates that Quebec has not provided its data since 2011, that is to say well before the COVID-19 era … A bad way to stand out.
Under the former Minister of Health Philippe Couillard, Quebec has created an organization, INLE (National Institute of Excellence in Health and Social Services). It is important to remember the term “excellence”. This makes it necessary to aim for innovation, to review preconceived ideas, to suggest ways for Quebec to come out of its health slump. I would venture to suggest that understanding what you are doing wrong should lead to directions for doing better. In a COVID-19 pandemic as in a cancer epidemic.
“There is no substitute for excellence. Not even success […]. This quote from Thomas Boswell, journalist and writer, particularly influenced by sporting exploits, brings us back to the function of the health system. Add life, health to life, wellness to health. We must add “for everyone” to this maxim which served as the foundation for the creation of our public health system.
There is no success in our public network as long as personalization does not leave political intentions, funding follows intentions, people in place to provide care feel their capacity to ask for diagnoses and treatment options. adapted to evolving science, to excel.