Could personalized medicine have prevented Germanwings flight 9525?

On March 24th, 2015, Germanwings flight 9525 crashed into the Alps, killing all 150 people on board. The flight’s co-pilot, 27-year-old Andreas Lubitz, had deliberately taken the plane down after locking the pilot out of the cockpit. There’s no doubt that many parties across the world are discussing what could have been done to prevent this tragedy. However, what is missing in this discussion is the potential of pharmacogenetic testing – also known as drug-to-gene interaction testing – to improve mental health.

Andreas Lubitz had a history of severe depression that had derailed him from his pilot training six years ago. Although Lubitz had been cleared as “100 percent flightworthy” by Lufthansa during his routine physical exam, the airline relies only on self-reporting for the psychological fitness of its pilots.

Several doctor’s notes were found in Lubitz’s home – including one that was torn and thrown in the trash, and one dated on the day of the crash – indicating that Lubitz was unfit to work. Lubitz had withheld his illness from his employer, likely from fear that he would not have been allowed to fly.

This fear by pilots of being stripped of their wings after disclosing mental health information influenced the Federal Aviation Administration in 2010 to change its policy, allowing pilots to fly while taking certain antidepressants – given that their illness is mild.

The problem is that these antidepressants do not work for as many as half of those who are prescribed them(1). Genetics plays a key role in how medications, particularly antidepressants, will react with a person’s body.

Currently, the most common prescribing model with antidepressants is trial-and-error. This means that to treat a patient with depression, the doctor would likely prescribe a common antidepressant almost blindly, hoping it will work for the patient. If the patient is in the 50 percent of people that are not genetically compatible with the drug, not only could the drug have no effect, it could bring upon side effects worse than the illness itself. The patient could go from simply being depressed to possibly becoming suicidal(2).

There now are affordable genetic tests, widely available in North America and Europe, which can easily determine a person’s medication compatibility – that is, which drugs will work for them, and which should be avoided at all costs. Instead of the blind trial-and-error method, this “pharmacogenetic” test provides the doctor with an additional tool to help prescribe the right drug at the right dose for the right person. This could mean the difference between life and death.

What if Andreas Lubitz had taken this test? What if his psychiatrist had prescribed the right medication for his genetics? What if he had not had suicidal thoughts, from either his illness or potential side effects? Perhaps he would have gone to work that day in a healthy frame of mind. Perhaps it would have saved not only his life, but the 149 other lives in his hands.

The question becomes now, why haven’t these tests been implemented into healthcare? Why aren’t governments paying for them? Why haven’t employers made them available for their employees, specifically those employees who are responsible for lives other than their own?

Germanwings flight 9525 should be a wake-up call for governments and employers to stop looking at suicide as untouchable and start looking at ways to prevent it.

References:

1. Spear et al. Clinical applications of pharmacogenetics. (2001) Trends in Molecular Medicine 7(5), 201-204.
2. Licinio et al. Depression, antidepressants and suicidality: a critical appraisal. (2005) Nature Reviews Drug Discovery 4, 165-171.