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Publicly funded genetic test for suitable antidepressants would save health-care costs: study

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Linda Riches, shown in this handout image, tried at least 12 different antidepressants before one worked for her.HO/The Canadian Press

Loss. That’s the word that comes to mind when Linda Riches thinks of the debilitating depression that robbed her of the ability to fully care for her son, advance in her career and pursue her goal of a PhD in education.

Riches, 67, said she was prescribed at least a dozen antidepressants, starting in her 30s, but they failed to lift her mood while she missed a lot of days in her job as a high school teacher. When she would return to work, she felt isolated and alone among co-workers she believed would have responded differently if she’d had a physical illness.

“If you’ve been off because of a mental health issue, people just don’t want to talk about it. So they ignore it. Nobody wants to come and say, ‘Is there anything I can do to help you?’ ” she said from her home near Prince George, B.C.

Years went by as she started to lose hope before one medication turned out to be the right fit.

Now, Riches says she hopes others can avoid a trial-and-error experience by having a genetic test to help predict which drugs would likely work best for them and cause fewer side-effects.

Known as pharmacogenomic testing, such personalized treatment is available for a fee. A lab examines DNA obtained from a sample such as from blood, saliva or a cheek swab to identify the genetic variants that affect how the patient would metabolize and respond to specific medications.

Riches is one of three patients who took part in a University of British Columbia study into the cost savings offered if pharmacogenomic testing were to be publicly funded.

A study published Tuesday in the Canadian Medical Association Journal suggests that providing the test as a standard part of care could save $956-million over 20 years for the health-care system in British Columbia alone. That excludes all the personal and economic savings from people returning to work, being able to afford child care and having a better quality of life.

Stirling Bryan, a senior author on the study, said more than 35 antidepressants are available in Canada but nearly half of patients do not respond to the first medication they are prescribed and about a quarter of those report intolerable side-effects.

Genes are responsible for about 42 per cent of the variation in how people respond to antidepressants, said Bryan, a professor at UBC’s school of population and public health and a senior scientist at Vancouver Coastal Health Research Institute.

Researchers accessed about 194,000 patients’ health data from 2015 to 2020. It included medications they were typically prescribed for major depression as well as clinical trial data linking genetic information to appropriate antidepressants. From that, they developed a simulation model for how people would fare over 20 years if they did not have pharmacogenomic testing compared with predictable outcomes with that testing.

Bryan said about 37 per cent of patients who don’t respond to various medications are deemed to have treatment-resistant depression, sometimes after they give up trying out of frustration, at which point they may need more doctors’ visits, including psychotherapy. They could also end up in hospital for electroconvulsive therapy (ECT) or other treatment, adding to health-care costs.

“One in 10 Canadians will experience major depression in their lifetime,” said Stirling, believing that widespread availability of pharmacogenomic testing could save billions of dollars throughout the country.

Beyond the financial savings, the study showed that an anticipated 1,869 lives would be saved over 20 years, Bryan said.

Few patients get a genetic test to determine which antidepressants could be best suited to them, but more people are choosing that option, usually by spitting into a tube they mail to a lab.

However, doctors may not know how to interpret someone’s genetic profile to help guide their prescribing decisions, said Bryan, urging more education on that through a program that would fund the testing.

Research on pharmacogenomic testing is also under way elsewhere in Canada.

Dr. Paul Arnold, a child and adolescent psychiatrist and director of the University of Calgary’s Mathison Centre for Mental Health Research and Education, is involved in a study for patients between ages six and 24 who are either starting on medication or about to switch to a different drug.

DNA samples have so far been collected from about 1,000 patients in Alberta, British Columbia, Saskatchewan and Alberta, but the goal is torecruitanother 2,000 children and young adults, Arnold said.

The study initially included participants up to age 18 but expanded because most mental illnesses start before age 25.

The samples are being tested by a publicly funded lab but the hope is that costs could eventually be covered by the Alberta government depending on findingsafter researchers analyze prescribing patterns and changes in use of health-care services, Arnold said.

“The exciting thing about pharmacogenomic research is that you can see the immediate impact,” he said. “The goal is to catch (patients) early, before they go through that journey of having been on multiple medications without success.”

Dr. Jitender Sareen, a psychiatrist who is medical director of the mental health program for the Winnipeg Regional Health Authority, said plans are under way to launch a study that would determine the impact of pharmacogenomic testing for hospitalized adults, including seniors taking medications for multiple conditions.

“Our aim is to recruit all adults but we wanted to start on our inpatient units because there is mixed evidence about whether this kind of pharmacogenomic testing can actually reduce the length of hospitalization,” he said.

Pharmacogenomic testing currently costs between $200 and $400, but providing it to everyone who needs antidepressants would benefits the health-care system, care providers in the community as well as patients, Sareen said.

“People get tired of trying different medications and this could at least help guide treatment.”

 

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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