As a part of my interview series with leaders in healthcare, I had the pleasure to interviewing Jennifer Hockings, PharmD, PhD.
Jennifer is a Pharmacogenomics Clinical Specialist in Cleveland Clinic’s Department of Pharmacy and Center for Personalized Genetic Healthcare. She is a board-certified Pharmacotherapy Specialist and is licensed by the Ohio State Board of Pharmacy. Dr. Hockings has published numerous peer-reviewed research articles in distinguished journals, including Cancer Research, Breast Cancer Research and Biochimica et Biophysica Acta, and has presented at professional association meetings including the American Society of Health-System Pharmacists and the American Association for Cancer Research.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
Thank you for having me. My post-graduate training includes a research fellowship at St. Jude’s Children’s Research Hospital, a pharmacy residency at Methodist University Hospital and a pharmacogenomics residency at St. Jude’s Children’s Research Hospital. Pharmacogenomics is a relatively new field that studies how genes affect a person’s response to drugs. Recent clinical research and work have shown that genetic testing can helps us personalize therapies for a wide range of medical issues, such as depression and anxiety.
In your opinion, what makes your particular field of medicine so interesting?
Pharmacogenomics is much like detective work. Testing of pharmacogenomics unearths clues on a patient’s ability to break down certain medications. That helps us narrow down the list of possible medications a patient may have to try and improves our chances of finding the one that works well — and with minimal side effects.
In psychiatry for instance, pharmacogenomics could help those struggling to find an antidepressant that works. This is especially helpful when you consider that, despite the number of antidepressants available, up to 50 percent of patients do not respond or experience side effects that lead to discontinuation of the first medication prescribed. Approximately an additional 20 percent of patients respond to a second antidepressant. Given that depression and anxiety can impact quality of life, studies show that patients who received antidepressants based on genetically guided information showed improved response and remission rates. With progress in pharmacogenomics research, we hope it may soon be incorporated into the standard practice of medicine. If that happens, we hope to see a dramatic reduction in the number of hospitalizations caused by adverse drug reactions.
Can you share the most interesting story that happened to you since you began working at Cleveland Clinic’s Genomic Medicine Institute?
I am constantly surprised and amazed by my day-to-day work at Cleveland Clinic’s Genomic Medicine Institute. There are such new and unique things happening in the field of pharmacogenomics.
One of my very first patients came to us with a diagnosis of bipolar depression. Before visiting us, the patient had tried several different medications that had either been discontinued because they did not work or because of side effects. The patient had an inpatient admission and took a leave from work. We met with the patient one-on-one to discuss what pharmacogenomics is, how it can help and the limitations of testing. When we provided recommendations back to the psychiatrist, we not only reviewed the pharmacogenomics results, but we also considered drug interactions and other important factors, such as liver function. We also try to take into consideration the potential cost of medication therapy. All of these factors (pharmacogenomics results, drug interactions, liver function and potential cost) contribute to the overall wellbeing of the patient. If a patient cannot afford the medications, then that drug may not be the best option for him or her — and we want to offer the overall best options for our patients.
After implementing a new medication regimen, this patient came back about three months later just to tell us that both work and social relationships were significantly better. The patient still periodically calls just to say hello. That’s why I do this job.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
Most of us have been through the experience of trial and error with drug after drug, as patients. And it’s frustrating. Finding the right medication — for any medical condition, from anxiety to chronic pain — can be like finding a needle in a haystack. Unfortunately, the longer it takes to find the right drug, the longer you suffer — and studies have shown that each failure may lessen the success of treatment even when the right drug is found.
For certain conditions, physicians may choose the first medication based on preference and/or past experience. But this can be a daunting task since individuals respond to medications differently. Sometimes, the response is prompted by our genetic makeup. Fortunately, research breakthroughs are helping doctors better understand the impact of genetics on how drugs work in our bodies through pharmacogenomics.
It’s ushered in a whole new field of medicine that has great promise for improving the response to drug prescriptions. By communicating the positive impact of the practice to the general public, our hope is that more patients will ask about it — and more physicians will use it to better understand their patients and their responses to medication.
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?
Pharmacogenomics is rapidly becoming an innovative tool to optimize therapy and minimize the risk of adverse effects, and it has topped the Cleveland Clinic annual list of the Top 10 Medical Innovations of 2019. It was a personal milestone that healthcare providers are recognizing pharmacogenomics as an important area in healthcare. It’s remarkable that this work is providing an opportunity to change how we practice medicine. We are truly making an impact on an ongoing issue in medicine. It’s momentous.
But, still, there are some challenges to its widespread adoption.
Some insurance companies have been slow to approve it. One reason is that there are currently no set recommendations for who should be tested. However, a large third-party payer recently announced coverage of testing for patients diagnosed with depression and/or anxiety and who have failed at least one antidepressant. This change in policy is a key step in its continual growth and eventual adoption.
As a patient, it’s important to talk openly to your physician, when medications are needed or a dosage may need to change. Other factors are important, too — such as age, weight, environmental factors and how drugs interact with other medications you may be taking.
I am thrilled for the advancement of this field and perhaps the days of trial and error prescriptions will soon be gone.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I like to find, and surround myself, with things that make me stay curious. My favorite books and podcasts are outside the realm of healthcare, such as history or work/life balance. In fact, it’s an eclectic mix and I enjoy getting my inspiration from across many sources.
I most recently listened to a TED Talk about math teachers and found synergies with my work of teaching the next generation about the field of pharmacogenomics. My favorite books are those I’ve read before but keep picking up over the years. One example is The Little Prince. I enjoy children’s books because they are full of optimism and inspiration. I read The Little Prince in high school and am just now realizing the deeper themes to the story. The book reminds me that perspective matters as well as an innate desire to explore and ask questions — much like myself and the field of pharmacogenomics.
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Thank you so much for these insights! This was so inspiring!