Personalized Medicine May Take a While

There’s enough progress to show that personalized medicine, also known as precision medicine, is possible, but it's not ready to influence daily practice of medicine.

Medical researchers love to discuss and dissect personalized medicine with an evangelical fervor. It’s hard to blame them. The promise of having your health, present and future, pinpointed down to your DNA is tantalizing.

Advances in technology already have the cost of doing personal genome sequencing down to less than $1,000, which brings personalized medicine closer.

As of 2021, medicines that are linked to genetic results (and so considered personalized) accounted for more than a third of newly approved drugs in the United States in recent years, up from less than 10 percent a decade ago. The progress with cancer is most impressive, with new therapies for lymphoma and small-cell lung cancer as notable examples. New testing allows oncologists treating breast cancer to focus on biomarkers rather than the tumor’s location.

In general, doctors are now able to profile tumors to fine-tune therapies.

YOU MIGHT ALSO LIKE: Our Personalized Medicine section

The Food and Drug Administration has now approved eight cell-based therapies, transplanting normal genes into a patient’s own cells, including two in 2021. Genome sequencing is increasingly helping public health departments track particular outbreaks of disease. Newborns are being screened for more genetically-based illnesses.

To take advantage of progress in personalized medicine, know your family’s medical history. In some cases, you may need genetic counseling and testing for a disease that runs in your family.

Use new technology to track your health between doctor visits. It’s easier than ever to know how much exercise you are getting, or to take your blood pressure at home. That information will help your doctor make your treatment more precise.  For example, you can monitor diabetes at home and fine-tune your insulin dosage. 

Yet more progress is needed for genetic information to influence daily practice of medicine.

Let’s establish ground zero, or what personalized medicine is, or is supposed to be. “Personalized medicine — or `precision medicine,’ as it has been termed by the (National Institutes of Health) — is a form of medicine that uses information about a person’s genes, proteins and environment to prevent (disease), diagnose and treat patients,” says Berta Strulovici, PhD, director of the Weizmann Institute’s Nancy and Stephen Grand Israel Center for Personalized Medicine.

“In the future, this knowledge will give doctors the ability to assess medical risks and monitor and treat patients according to their specific genetic makeup and molecular phenotype,” she adds. This approach to medicine is proactive rather than reactive. Such a center is certainly needed to make personalized medicine a reality: a focal point for the vast technology, talent, and interdisciplinary cooperation that can tackle a discipline of such complexity.

That’s progress, but you’re still not going to find out any time soon that you are destined for heart disease or cancer because a molecular screening says so.

Here’s how the debate goes.

Eric Topol, MD, the director of the Scripps Research Translational Institute, says in his 2012 book on the subject that the digital revolution will bring about the “creative destruction” of medicine as you know it. Technology, specifically wireless sensors or apps, combined with the study of genes, imaging, and social networks that concentrate on health, will bring about the personalization of drugs, devices, screening tests, and treatments.

On the other hand, the whole idea of personalized medicine “is a myth. It’s hyperbolic,” said Ezekiel Emanuel, MD, PhD, chairman of the department of medical ethics at the University of Pennsylvania, during a panel discussion in 2012 that included Topol. Emanuel added that medical treatments based on individual characteristics are too optimistic and too expensive.

Topol has countered that the promise of personalized medicine is already becoming intrinsic to today’s cancer research. Several cancer centers, including MD Anderson and NantHealth’s Patrich Soon-Shiong, MD, Topol notes, have been sequencing patients’ genomes to identify the first glimmer of tumors. Then, presumably, they can tailor a treatment rather than taking a shotgun approach with powerful drugs that have horrible side effects.

Emanuel, though, has pointed out that behavioral and lifestyle changes like a better diet, smoking cessation, and exercise are likelier to influence longevity and affordable healthcare than genetics. Add myriad, complex environmental factors, and genetics becomes just another piece of the puzzle, wrote David Ewing Duncan in the MIT Technology Review.

In a review of a book by Francis Collins, commonly seen as the father of human genome sequencing while he was head of the Human Genome Project, Duncan writes that Collins puts an “overwhelming emphasis on genomics as the language of life.”

“Each of us is born with a genetic blueprint, but this is meaningless for most common diseases without understanding the interaction of the environment and our personal genetic proclivities for either sensitivity to or protection from assaults from the world we live in,” he writes.

Given those factors, what’s missing from Collins’ determined continuing education (of you) on what genomics mean and what they might offer healthcare is a plan that fits all the puzzle pieces together, Duncan contends.

In any event, Topol believes his theory of positive disruption is already unstoppable. Personalized medicine is a matter of when, not if, he believes.

The irony of all this is that the pinpoint focus of personalized medicine will bring the family doctor back, says Jeff Balser, CE0 of Vanderbilt University Medical Center.

“After having gone through a period where blockbuster drugs and massive screening were the norm, we are actually moving back to a place where we’re trying to tailor care to the individual. I try to think of this as not getting more high-tech and therefore more distant from the patient. Through technology we’re becoming more familiar with our patients as individuals and, along with that, always remembering to be personable.

YOU MIGHT ALSO LIKE: Our Healthcare Choices section