Precision medicine: a customised journey | PDD

Precision medicine: a customised journey


on August 8 2019

Customisation and personalisation; concepts that are rapidly becoming “de riguer” for the millennial generation. The consequence is that expectations around tailor made solutions are growing. Clothes that fit us to the inch, nutritional apps adjusted to our dietary preferences and on-demand media that can guess our next favourite show. What would have sounded like a science-fiction movie over a decade ago represents the modern reality and the widening range of technological developments. These advances will empower individuals and make it possible to control every aspect of our existence through increased choice, flexibility, relevance and targeting.

In healthcare we are already seeing a profound impact. From genetically-adjusted treatments that respond to each of us differently, to data analytics that show what diseases could affect our bodies in the future; precision medicine is slowly but surely revolutionising the healthcare industry. What sets it apart from conventional medicine is its unique way of using gene research and data analytics.

Precision medicine therefore allows us to ‘tailor prevention, diagnosis and treatment to a person’s unique biochemical makeup’. While conventional medicine tends to assign patients to a treatment generally used for a category of illness, precision medicine is different as it involves a customisation of healthcare where medical decisions, treatments and practices are tailored to each patient’s gene, environment and lifestyle.

Precision medicine vs personalised medicine

Precision medicine is sometimes referred to as personalised healthcare but one should be cautious about the equivalence between these terms. As pointed out by the US National Research Council (NRC) ‘personalised medicine’ may be different as it implies the use of data and genomics to create individualised treatments for each patient’s needs. Precision medicine is different (according to the NRC) as it is not necessarily ‘the creation of drugs or medical devices that are unique to a patient, but rather the ability to classify individuals into sub-populations that differ in their susceptibility to a specific treatment.

So far, precision medicine has proved to be a life-saving method for several patients suffering with complex illnesses. The dramatic recovery of a woman diagnosed with metastatic breast cancer is only one example of how one’s own immune system can be harnessed to attack and kill cancerous cells. The tumour’s DNA was sequenced and analysed by an immunotherapy team which later extracted an array of immune cells to see whether these would recognise the tumour’s genetic flaws. The ‘winning’ cells were then reproduced in vast amounts and infused into the patient. Years later, the woman presented no signs of cancer.

             Image credit: National Geographic

Where can conventional medicine go wrong?

Blockbuster drugs are usually expected to have the same effect on a wide spectrum of patients, but this is not always the case. For instance, over 25% of the World’s population has a gene variant that produces a defective form of an enzyme needed to activate clopidogrel– a drug usually prescribed to prevent blood clots for patients who have experienced a heart attack.

This can have a profound impact – for example Alan Shuldiner, a professor of medicine and genetic researcher at the University of Maryland, discovered that the risk of having a second heart attack or dying within a year is doubled for those who take this drug and have the gene variant (when compared to those who don’t have the variant). This is promising; however screening patients for the variant is by no means a routine procedure. At the same time prescriptions are generally directed at an average, not a dose that is matched to an individual (including their genetic makeup). This further highlights the importance of understanding how genetics work to be able to match each patient with the right dosage of each drug and minimise costs. Therefore the growth of precision medicine not only provides us with a new toolkit – it challenges conventional forms of medical practice.

Brave new world? 

Regardless of geography – expectations are changing. It is not only millennials that want to see the benefit from tailoring and customisation – precision medicine has the potential to save and extend life regardless of demographic. For many countries, changes in population, growth in Long Term Conditions (LTCs) and changes in the ratio of caregivers to cared for is forcing a rethink in the way that healthcare is provided. There is a move towards preventative measures and life-long interventions.

Image credit: Apple

This approach goes hand in hand with the rapid growth in technology associated with epidemiology, epigenetics and public health (including precision medicine). Private providers play an important role in this capability. For example each of the Big Four tech companies (Alphabet, Amazon, Apple and Microsoft) are currently developing solutions for the healthcare industry. While Alphabet is focusing on data analytics to become the leader in population health, Amazon is developing Alexa into an in-home health concierge, Apple is converting its gadgets into patient health centres and Microsoft is using its cloud storage to support precision medicine. Although this work is not without challenge, the delivery of precision medicine is happening at scale.

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