Digital Health Hope: Personalized Care Is the Final Frontier
This is the final part of RealClearHealth's five-part series: The Digital Health Hope. Dr. Kevin Campbell explores the world of potential that digital health offers. Read the rest of the series here.
For many health care providers, personalized or precision medicine is the holy grail of their practice. While we have made great gains as new technologies develop, progress in medicine in the past decade has been lacking despite all-time spending highs in research. In order to improve outcomes and make significant progress, physicians must accept change and move toward the more precise approach that personalized medicine affords. Today, medicine revolves around standards of care: the best courses of prevention or treatment for the general population, or the average person on the street—not necessarily what is best for the individual. In personalized medicine, physicians cater medical treatment to a patient based on their particular genetic, environmental and clinical information. This personalized approach results in a more precise treatments that are much more likely to be effective.
The ability to treat a patient with a specific disease or ailment with a targeted therapy that will result in more accurate diagnosis, earlier intervention, and more efficient drug treatments is essential to improving outcomes. Believe it or not, millions of people are taking medications that are unlikely to help them. In fact, the top 10 highest-grossing drugs in the United States only help 1 in 25 patients that take them. With health care costs skyrocketing, we must become more efficient in the care of patients.
We must remember that none of this would be possible prior to the availability of digital technology and tools. For example, there's 6 billion base pairs in human DNA, without digital advances the sequencing of these pairs would be impossible. What used to take months can now be done in weeks. The data that must be processed in order to practice a personalized medicine approach is enormous--especially if you consider years of medical research plus a lifetime of doctors' notes along. The technologies of digital health offer powerful tools to clinical researchers, whose challenge now to utilize these tools to provide reliable information that can impact the way physicians care for patients.
Genomics Paves the Way
After decades of work, the completion of the Human Genome Project in 2003 has made personalized medicine a reality. The genome contains our DNA, the code for the genes that make us who we are. Remarkably, only 2 percent of the genome actually codes for our genes--the rest of our DNA is considered to be non-coding regions. On the whole, this is the architectural blueprint for our bodies and determines everything from our physical appearance to our likelihood for developing certain diseases and how we respond to treatments..
Personalized Medicine Today
While many advances have been made, personalized medicine remains in its infancy. The most progress has been made in the area of cancer therapies. Now, there are many genetic tests for genes that are known to be associated with particular cancers. These tests allow doctors and patients to make informed decisions not only about treatment but also about prevention. In a very controversial and high profile example, Angelina Jolie chose to have a radical bilateral mastectomy after learning that she carried the BRCA -1 gene that made the development of breast cancer a near certainty. Cancer is probably the area where personalized medicine is growing the fastest. Matching particular chemotherapy agents with particular tumors in a genetically unique patient is becoming commonplace and is likely to be the area of most dynamic growth in the next decade.
Another example of precision medicine today includes the molecular profiling of microbes—in other words, by understanding the genetics of a particular bacteria and a particular patient a non-resistant, effective antibiotic can be chosen.
This type of work will allow for more efficient, potentially life-saving decision making by physicians particularly when dealing with critically ill patients with multiple infections.
Researchers are also using genomics and precision medicine to look at new ways to treat chronic diseases such as cystic fibrosis and cardiovascular disease. In addition, precision medicine will address how patients metabolize particularly important cardiovascular drugs such as plavix and warfarin (among others), ultimately improving patient safety.
The Future of Personalized Medicine
Personalized medicine offers numerous advantages over the traditional approach to health care and these will continue to develop in the next decade:
1. Ability to make more informed medical decisions
For physicians, more information is always better. In order to come up with a diagnosis, doctors create a differential diagnosis based on the data they are given about a patient and a disease. Then, testing and treatment trials help narrow the “differential” to a particular singular diagnosis and treatment then commences
Adding genetic information will allow access to even more data—physicians will be able to assimilate the information and make more directed testing and treatment decisions.
2. Higher probability of desired outcomes thanks to better-targeted therapies
When we better understand a disease and how the disease may manifest in a particular patient and how it may interact with potential therapies, we are able to quickly choose a treatment that has the highest likelihood of success. In traditional medicine, many therapies may be attempted in succession in an effort to find the “best” treatment. Personalized medicine will provide information that will allow physicians to choose a highly successful therapy much earlier in the disease process.
3. Reduced probability of negative side effects
As we all know, most treatment have side effects. The degree to which these side effects impact an individual patient is quite variable. By using a personalized medicine approach, physicians will be able to determine in advance which treatments are likely to produce negative side effects in a particular patient and avoid the use of that therapy. In medicine, we must always balance risks and benefits. Genomics enables doctors to be much more precise in choosing therapies that have a favorable balance for each and every patient.
4. Focus on prevention and prediction of disease rather than reaction to it
For far too long, health care in the US has been focused on the treatment of disease rather than prevention. While much lip service is given to disease prevention, the continued high prevalence of obesity, diabetes and cardiovascular disease argues that we are not doing a great job in this space. Personalized medicine will allow physicians to examine the presence of genetic, environmental and lifestyle-generated risk for disease and better predict which patients are most likely to develop a particular illness. By identifying high-risk patients particular therapies and targeted preventative strategies can be employed.
5. Earlier disease intervention than has been possible in the past
In medicine today, we spend far too much time testing and zeroing in on a diagnosis. In many cases, diagnoses are incorrect and patients are treated improperly for months or even years. Now, with the advent of personalized medicine and the large amount of data that is associated with each patient, physicians will be able to intervene with appropriate therapies much earlier in the disease process. Early intervention can make the difference in whether or not a patient survives a disease as well as their quality of life following treatment.
Personalized medicine is the future of medicine. The precise data obtained on each patient that tomorrow’s physicians will be able to access and apply to individual treatments—rather than using population generated data to determine therapies—is likely to result in cures for many disease that were once considered incurable. No longer will medicine apply a “one size fits all approach” to the treatment of disease. I expect that each of us will one day carry a smartphone app that contains our own genetic code and that each time we see a doctor, our treatment will be catered to exactly who we are.