Is It Time For Us All To Invest Big Bucks in Personalized Healthcare? We Get The Scoop

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Personalized healthcare 101

Forget annual checkups with your family doctor — the future of medicine is far more sophisticated. Instead of simply sharing symptoms with your physician, and then hoping for the best, today you can completely customize your health care — from health concierges and genetic testing to health coaches — if you’re willing to pay for it.

Private clinics and companies across Canada now offer an array of personalized services, from medical concierges, to healthcare coaches, to genetic testing, all with the aim of helping you live your healthiest life.

But, the big question remains: Are they worth it? Well, if you are the sort of person who, upon knowing your risks, actually changes your lifestyle for the better, then many services may offer real benefits. Additionally, patients who are managing a complex disease or condition could benefit from more one-on-one attention if they are not able to receive it from their regular healthcare providers.

But, because there are so many services out there, it’s key to do your research and hone in on the kind of care you really want, because one thing is 100 percent certain: These services cost a lot of money.

Here are three ways (including a unique take on genetic testing) that Canadians can personalize their health care.

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Healthcare concierge

Almost everyone has felt the frustration of being sick and unable to get in to see their doctor. Only 43 per cent of Canadians were able to get a same-day or next-day appointment at their doctor’s office the last time they needed medical attention — the lowest percentage of the 11 Commonwealth countries surveyed, according to the Canadian Institute for Health Information. And while there are no hard stats on the average appointment times, it’s commonly known that most family physicians only offer patients 10-minute time slots to discuss their concerns. But studies have shown that longer visits can improve several aspects of care in terms of both prevention and patient participation. Enter the concept of a healthcare concierge.

Imagine having your doctor on call to address your every health concern when and where you need it. Private clinics that offer concierge services are popping up across the country to address these proactive patients. One such option is Vancouver-based health and wellness clinic Qi Integrated Health. For a membership fee of $2,500 a year, patients have full-time phone and email access to a physician and a digital portal where they can track their health records online. Qi also offers holistic care referrals, to a team that includes a massage therapist, chiropractor, acupuncturist, traditional Chinese medicine doctor, osteopath, physiotherapist and even a Pilates instructor, for an additional cost.

“The main thing I hear [from patients] is that it’s nice to have someone be present to listen to what they are saying and how their system is affecting them, and for me to explain what we are going to do and make a treatment plan,” says Dr. Bryn Hyndman, the medical director at Qi. In addition to referrals, longer appointments and on-call care, the clinic facilitates DNA tests ranging from full genome sequencing to pharmacogenetic testing and provides medical context and guidance based on the results.

Plenty of other companies also offer private healthcare services, though not all have such a holistic bent. Medcan, located in downtown Toronto, offers a full diagnostic workup, a team of doctors and nurses on call, as well as referrals and an online digital health portal, starting at $2,595 per year for a healthcare assessment. Copeman Healthcare, with locations in Alberta and British Columbia, ranges from $1,850 for a full assessment to $4,495 for year-long private health-care concierge services.

While these services are definitely an investment, customized healthcare services help put patients in charge of their own health, which can be especially important for those managing chronic health issues, says Dr. Hyndman. “When people could get something for free but instead pay for it there’s a reason,” she says.

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Genetic testing: Part 1

Personalized medicine has become a buzzword among the medical community and for good reason — managing your risk of disease has become easier and more accessible with the advent of DNA testing. But you’re not going to be offered a full genetic workup at your family doctor’s office just yet, so many patients are turning to direct-to-consumer services to find out their risk of future diseases.

One of the more popular genetic medicine services, 23andMe, an American company with more than two million clients worldwide, offers customers a look inside their genome, reporting on approximately 70 health conditions and traits. The data is analyzed through spit, which customers mail to a lab. In approximately six to eight weeks, individuals receive online reports on their genetic health.

There are only four main disease risks that the company currently reports on, including late-onset Alzheimer’s disease, Parkinson’s disease, alpha-1 antitrypsin deficiency, a disorder that causes lung and liver disease, and hereditary thrombophilia, a blood-clotting disease. The company can also inform customers of their carrier status risk, meaning genes linked to a condition that is recessive so the individuals will never actually develop it themselves, but they can pass it on to their children. This panel covers 42 diseases and disorders such as cystic fibrosis, Tay-Sachs disease and sickle cell anemia. 23andMe also offers genetic information on things such as muscle composition, weight, sleep, and lactose intolerance.

The company is careful to note that your results won’t tell you that you currently have or will develop any specific diseases — the report simply tells you whether you carry one of the variants they test for. The test rings in at $249, and while it might offer some interesting information, it may not be able to offer the full breadth of data that you really need if you are worried about your genetic risk of serious conditions such as cancer or heart disease.

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Genetic testing: Part 2

But, individuals can choose to use the information they receive and take a more active role in their health, says Jhulianna Cintron, senior product specialist on the customer care team at 23andMe. “We’ve had customers tell us that the information we give them has been empowering,” she says. “If [a customer finds out] they have a risk for a certain disease they can do more research on it, they can do clinical trials.” Or, if they find out they carry a variant for something like lactose intolerance, it can lead people to make dietary and lifestyle changes, she says.

But many doctors caution against the use of direct-to-consumer genetic testing for a few reasons. “My concern is that [many companies] are not using the most cutting-edge research,” explains Dr. Guillaume Paré, an associate professor of pathology and molecular medicine at McMaster University.

“If they did so, they wouldn’t base their score on a handful of variants, because we know for all of these diseases there are thousands of [genetic] variants associated [with a disease] and it’s really the combination of these variants together that matters.”

For example, even if a patient has a gene strongly associated with the development of Alzheimer’s disease that is only one small factor associated with cognitive decline. Dr. Paré is not sure that direct-to-consumer companies are making this clear to clients and finding out this information without full context could cause unnecessary stress and confusion.

Dr. Lorne Clarke, medical director of the Provincial Medical Genetics Program at BC Women’s Hospital + Health Centre agrees that patients should not try these at home. “I do not recommend this type of testing in an individual’s management of their healthcare,” he says.

“Genetic testing can play a very important role in health care when the testing is organized and arranged by a healthcare provider who is knowledgeable of the patient’s medical condition or family history and can assess the medical significance of the testing and counsel the individual appropriately.”

Dr. Hyndman agrees that having professionals help you manage the data received is key, but is generally in favour of the idea. “Genes tell us what may or may not happen and it’s the environment that our genes are in that determines what switches on or off. The idea is that using the genetic testing we can monitor how your body is reacting to lifestyle changes and medication to see if you are trending away from disease or towards it,” she says.

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Health coach

A coach isn’t just for sports — you can now hire a health coach to help you manage everything from your general health to your diet, nutrition and exercise goals.

“The majority of people who come to me, who are more serious about making changes, are people who have had some kind of scare,” says John Kahn, a freelance physical health and nutrition coach in Toronto. From a medical diagnosis to an acute injury, Kahn sees clients who are looking to manage their long-term health through guided nutrition and exercise. He not only meets with clients for a full assessment, he also looks over their medical records to create a comprehensive plan. For about the cost of a personal trainer ($80 per hour) Kahn coaches his clients using an evidence-based approach to map and measure their progress towards their health goals. But keep in mind, all coaches are not created equal. There’s a wide range of both medically focused coaches, such as registered nurses who can help patients manage medications, and lifestyle focused coaches, who manage diet and exercise. Look for a coach with a health education background or medical training through a certified organization.

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