Inside Karl Pringle's plan to disrupt the centuries-old approach to drug therapy — and save thousands of lives in the process
The CEO of GenXys on how his startup — through science and software — will put an end to one-size-fits-all treatments and bring prescriptions into the future.
Karl Pringle, the chief executive of GenXys, was on the other end of my Zoom call, and he was incredulous. No, actually, he was just worked up; I’m the one who was incredulous. He had just told me that 50% of drug therapies don't work as expected. I researched this later and also learned from the CDC that half of all prescriptions are taken incorrectly with regard to timing, dosage, frequency and duration. “I mean, that's just staggering,” Pringle continued. “Most people outside of the health industry — you hear that statistic for the first time and it's mind-blowing.”
Unfortunately, the numbers get worse. Every year in Canada, there are around 200,000 severe adverse drug reactions, killing between 10,000 to 22,000 Canadians. According to Adverse Drug Reaction Canada (ADRC), this costs the health care system between $13.7 and $17.7 billion — and globally, the number is pegged at $130 billion. Part of the reason is that in many ways, the approach taken to treat illnesses hasn’t changed in a very, very long-time, Pringle explained during a recent conversation.
It’s as though the age of innovation has passed parts of the healthcare sector by. Yes, there are new drugs and treatments; but in many cases, when doctors are prescribing medications, it’s trial and error. Try this, if it doesn’t work, come back and we’ll try something else. Pringle believes it doesn’t have to be that way, and his company, Vancouver-based GenXys, is out to solve this problem.
Founded in 2014, GenXys has developed what it’s calling a “platform for precision medication management” that integrates pharmacogenomic data (hang around for a lesson on that shortly) with a patient’s health record to identify personalized treatment and drug options. More simply put, what GenXys is working on will help clinicians prescribe medication for you that will actually work. To date, the startup has raised around $5 million in private capital, signed major channel and technical partnerships, and as I learned from Pringle, is poised for significant growth as the global market for genetic information explodes.
The genesis of GenXys...
...begins with UBC Professor Martin Dawes. He was passionate about pharmacogenetics — the study of how genes affect the body's response to certain medicines — and he believed that it should be used by clinicians in providing care. He did in-depth research into the space and believed that the best way to use pharmacogenetic insights was to combine them with other patient data points. As part of Professor Dawes’ investigative work, he developed a proprietary pharmacogenetic test as well as software that interpreted the data from it. Taken together with other patient information, the resulting insights could tell a doctor, “Hey, these are the optimum and safest medications for this patient based on all their individual characteristics,” Pringle said.
So GenXys was born. It was learning how to walk, and it needed a professional CEO to come in and teach it how to run. Enter Karl Pringle. “I didn't need to come in as a health expert or as a scientist or a geneticist,” Pringle shared. “Plenty of those kinds of people in the company already that had all of that expertise. What they were missing was a software guy, someone that could come in and say, ‘Hey, how do we take this software and make it enterprise-grade and take it out to the market?’”
Pringle was introduced to the business in 2018 and immediately saw its value. “I said, ‘Yeah, we have the testing, and we have the software and the software is really unique. That's a game-changer,” he recalled. The company also had the trend of increasing awareness and adoption of pharmacogenetics on its side. The reasons for this are twofold: The first, according to Pringle, is the fact that 97% of the population has at least one pharmacogenetic variant which is going to influence how the person metabolizes medications. The second reason is that the world is becoming more accustomed to how genetics plays a role in their health and the delivery of their healthcare.
With those two factors in mind, the GenXys team has a strong belief that at some point during our lifetime, every baby at birth will have a pharmacogenetic test, and those results will be with them for the rest of their life. “And it's how [the results] can be utilized at the point of care that is really important,” advised Pringle. “That's where we focus on.”
To illustrate how GenXys actually works...
...from the point of view of the patient, Pringle asked me to think about a man named Bob and three scenarios.
For scenario one, Bob goes to his doctor and says, “Hey, doc, I’ve been on this medication for my anxiety, and it hasn't really been working. I heard about pharmacogenetics. Maybe that's for me.” The doctor says, “Yea, why don’t you go and get a test.” Bob leaves, gets his test and pays for it out of his own pocket. The results get sent to him and his doctor, and they both go from there.
For scenario two, Bob has a health insurer that calls him and says, “Hey, Bob, we see that you've changed your medications twice for your anxiety. We think that pharmacogenetics could help you determine what the best medication is — and we’ll cover the cost of that test for you. Here's the link to the website, go and order it. It's super simple, and your doctor and pharmacist will get the results and make sure you're on the right medication.” In that situation, it’s the insurer recognizing that a test could lead to better health outcomes and ultimately, lower healthcare costs.
Finally, there’s a third potential scenario where if Bob was paying for private health care, which is less common but still available in parts of Canada, that his pharmacogenetic test would be provided as part of the private service.
The economics of who pays matter because…
...they will determine how successful Pringle will be in building GenXys’ business. While payment it’s typically out of a patient’s pocket now, Pringle said there is an increasing trend where insurers are covering the cost of pharmacogenetic software like his. For example, in a potential industry first, GenXys has partnered with health benefits provider GreenShield Canada (GSC) to provide its members with a comprehensive test fully covered. “This endeavor is all about getting the right drug to the right person at the right time,” explained GSC’s Mark Rolnick, back in August when the deal was struck.
However, insurers are just one of three main customer segments Pringle is focused on. The main one is what he calls health systems. In BC, it’s the health authorities, and in the US, its a range of healthcare providers like Kaiser Permanente and CVS. The final segment includes lab companies that do pharmacogenetic testing. GenXys licenses its software to them so they’re able to rapidly analyze and interpret raw genetic data and make it usable for healthcare providers.
While the GenXys sales and marketing team is focused on those three different segments, it’s currently seeing the most traction with the pharmacogenetic test companies. “They're really the route through to the health care systems,” Pringle said to me, “because the health care systems are ordering the pharmacogenetic testing from the labs and the lab says, ‘Yep, great, we can do the test. We'll take care of that, and actually, you're now going to get the results through to you from this wizzy software by this Vancouver-based software company.” I mean, I don’t know if they’re saying that exactly, but I got Pringle’s point.
For Pringle to see his vision through…
...a lot has to go right. Firstly, GenXys needs a standard reimbursement model for pharmacogenetic testing. There needs to be consistency and predictability in terms of who will actually pay for the tests. Secondly, they need improved interoperability of electronic medical records which would facilitate better information sharing with GenXys’ partners. “Interoperability is absolutely crucial,” Pringle insisted, and his team is making progress on this front with multiple recent software integration announcements.
Thirdly, Pringle needs clinicians to be more open-minded and understanding of the role pharmacogenetics can play in patient care. “A lot of this is down to education,” he said. Fourthly, an operational shift is required in such a way that test requisitions are no longer restricted to doctors — translation: a world where patients could order tests themselves.
When asked what could go wrong, Pringle said that it would be those key developments not happening. But the evidence — literally 1,400 scientific articles — by his count, points to the effectiveness and importance of pharmacogenetics, so he’s currently carrying an air of optimism.
“You know, it all comes down to the fact…”
“...that we are disrupting and digitally transforming a centuries-old approach to prescribing, which is trial and error,” Pringle noted. “Try this William, if it doesn't work, or you start coughing, come back, and we'll try something else. Rewind the clock a couple of centuries, and it's William, we're going to put leeches all over your body, and if the leeches don't work, then we're going to drill a hole in your head, but it's only going to be a small hole. And hopefully, that will work.”
The world has changed. From sports to banking to agriculture, technology has enabled professionals in most industries to bring sophistication to the work that they do to solve the problems in front of them. If Karl Pringle gets his way, the same level of precision will be harnessed to improve healthcare outcomes. Though he runs a small software company born out of a UBC lab corner, the way Pringle sees it, his company is enabling the conditions globally to bring confidence and preciseness to prescriptions. His vision is already becoming a reality. “Patients are leaving a clinic, or shutting down their telemedicine Zoom call,” he boasted, “knowing that the medication is going to work for them.”
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