Personalized Medicine and You
The idea of personalized medicine isn’t new. Doctors have always strived to provide individual care to patients. But today’s definition of how doctors can do that is decidedly more specific.
Personalized medicine is to conventional medicine what conventional medicine is to Hippocrates assessing the four humours. Its potential has opened an amazing universe of possibilities, a universe that’s unfolding at the same exponential pace as the technology and research that drive it.
Personalized medicine can detect the earliest stages of diseases and prevent them from developing beyond those earliest stages. This alone has already had a dramatic effect on the quality of health care in America and around the world. It also holds the great potential of giving more patients access and driving down costs.
“Health care today is in crisis as it is expensive, reactive, inefficient and focused largely on one-size-fits-all treatments for events of late-stage disease. An answer is personalized, predictive and participatory medicine.”
Ralph Snyderman, M.D.
Chancellor Emeritus, Duke University
So, what exactly is personalized medicine?
The National Human Genome Research Institute defines personalized medicine as an emerging practice of medicine that uses an individual’s genetic profile to guide decisions made in regard to the prevention, diagnosis and treatment of disease.
To fully understand its impact and its potential, you have to go back to its birth, the Human Genome Project.
In 1990, the National Institutes of Health (NIH), the Department of Energy and international partners came together to sequence all three billion letters, or base pairs, in the complete set, or genome, of DNA in human beings. The goal of the Human Genome Project (HGP) was to provide researchers with powerful tools to help understand what role genetic factors play in diseases. The team conducted the work with disciplined respect for ethical, legal and social implications.
It’s hard to imagine any of the participants being able to predict the number of new strategies for diagnosing, treating and preventing diseases, or the biotechnological revolution their work unleashed on the medical community.
Impact on personalized medicine
To get a sense of the direct impact the HGP has had on prevention and treatment, researchers have discovered more than 1,800 disease genes since the project was completed, and at least 350 new technology-based products are currently in clinical trials.
Doctors can now perform genetic tests to see how patients may respond to treatments and procedures across major health care categories, including heart transplants, obstructive coronary artery disease, cystic fibrosis, inflammatory bowel disease, lung cancer, breast cancer, prostate cancer, colorectal cancer and melanoma.
Pharmacogenetics and pharmacogenomics
Two branches of pharmacology are fueling the explosion of new drugs to treat major illnesses. One is pharmacogenetics, which deals with how a person’s individual genetic factors react to drugs. The other is pharmacogenomics, which uses DNA and amino acid sequence data to inform drug development and testing.
“We are on the tipping point of a whole new game in how we develop drugs for cancer.”
Janet Woodcock, M.D.
Director, FDA Center for Drug Evaluation and Research
As a direct result of the HGP, there are now drugs that exist or are being developed to combat pain, cystic fibrosis, HIV, hepatitis C, tuberculosis, leukemia, lymphoma, lung cancer, colon cancer, breast cancer, pancreatic cancer, stomach cancer, psychotic disorders, depression, ADHD, bipolar disorder, insomnia and Tourette Syndrome.
Impact on costs
To get a sense of the time and cost impact the HGP has had, and the subsequent potential for significant cost savings, when the project began in 1990, sequencing a genome took six to eight years and cost $1 billion. In 2003, when the HGP ended, sequencing took three to four months and the cost was between $30 and $50 million. In 2013, sequencing can be done in one day and cost as little as $3,000.
“Personalized medicine will allow this country to attack health care in a way that will provide for prevention and therefore ultimately address cost effectiveness.”
CEO, GE Ventures & healthymagination
Personalized medical care has the potential to reduce health care costs in the U.S. It can help reduce trial-and-error dosing, hospitalizations due to adverse drug reactions, late diagnoses and reactive treatment.
A recent report estimates that a genetic test for the KRAS gene prior to treatment for metastatic colorectal cancer could save patients as much as $604 million a year.
For example, genetic testing to target dosing of the blood thinner drug Warfarin led to almost one-third fewer hospitalizations overall. A joint Mayo Clinic-Medco test produced similar results when genetic information was available to doctors prescribing the drug.
Imagine Hippocrates with a smartphone
Personalized medicine holds the promise of more preventive measures based on individualized analysis. More targeted interventions. New, more effective drugs. Better access to health care for more people. A more affordable health care system overall.
The success of the Human Genome Project and the move to this new definition of personalized medicine has already inspired the Cancer Genome Atlas, an initiative whose goal is to identify all the genetic abnormalities seen in 50 types of cancer.
“Personalized medicine is our chance to revolutionize health care, but it will require a team effort by innovators, entrepreneurs, regulators, payers and policymakers.”
Partner, Kleiner Perkins Caufield & Byers
You have to like the potential and the promise of where health care will be in five, 10, 15 years. Two things are certain: Change is coming fast. And the smart companies will do everything they can to keep up.
1. The National Human Genome Research Institute (www.genome.gov)
2. U.S. Department of Health & Human Resources