Precision medicine is changing how we prevent, diagnose, and treat disease. Is the landscape of healthcare evolving fast enough to keep up?
Today the average drug or medical procedure is designed for the average patient, a profile that very few ever match exactly. A more modern approach to the discipline known as precision medicine promises to leverage big data, genomics, and other technologies to usher in another revolution, with results already piling up just as some major new initiatives get underway.
Personalization Giving Way to Precision
Doctors have long sought to provide patients the care most suitable for their unique situations and needs. The large-scale drug trials that establish particular pharmaceuticals as safe and helpful to many, though, often conceal failures of an almost equal scale.
The same goes for therapies which prove, over the course of thousands of trials, to do more good than harm: a great many of these also do very little for almost as many patients as they help.
That is not to say that today’s medicine always paints with such broad brushes. Blood transfusions have for many years accounted for the particular type of the recipient, and allergy treatments similarly focus in on the specifics of any such immune system failure.
Until recently though, potentially telling factors like genome makeup, environmental conditions, and lifestyle has largely gone without notice.
The promise of precision medicine is that patients will one day receive care that better accounts for the individual details that make them unique, and that they will prosper because of it.
The Fight Against the Most Dreaded Disease Yields Some Real Answers
Some of this promise is, in fact, already being realized. Cancer has long been recognized as both an increasingly significant scourge of aging populations and a family of diseases where improved precision will be especially valuable.
A recently detailed meta-study to be presented at the annual meeting of the American Society of Clinical Oncology adds to some positive results in the field.
Assessing the outcomes of hundreds of “Phase 1″ cancer studies, the researchers found that highly targeted treatments were successful at shrinking tumors nearly a third of the time, compared to a success rate of fewer than one in twenty for those of a generalized kind.
With similar results from Phase 2 and 3 studies already well established, the study highlights how productive genomic and molecular targeting of particular tumors can be at any stage of development.
Public and Private Forces Align to Push for Progress
In last year’s State of the Union address, President Obama unveiled a new program designed to help move things forward. With $215 million in the 2016 federal budget flowing out through the country’s Precision Medicine Initiative, government agencies ranging from the Food and Drug Administration to the Department of Defense have gained a targeted new source of funding.
The National Institutes of Health hopes to enroll a million or more Americans in its voluntary Precision Medicine Cohort Program, collecting DNA, health, and lifestyle data about them that will be plumbed for new insights and potential treatments.
The U.S. Department of Veteran Affairs has a similar effort of its own underway in the form of the Million Veteran Program, with the VA already sponsoring eight promising projects that hope to make good use of the data it has collected.
Even in the face of these centralized efforts to tackle the large-scale problem of providing precise care, private groups are moving forward eagerly, as well.
Companies like New Zealand-born Orion Health are providing just the kind of technological savvy and responsiveness that the private sector is well known for, whether in partnership with government agencies or in support of other for-profit organizations.
Challenges and Practical Plans to Overcome Them
No one supposes that the dream of curing cancer or finally tackling the world’s obesity problem will be realized without trouble. Aside from the many advances occurring in the sphere of oncology, precision medicine remains largely an aspiration, even if concrete results concerning “inherited genetic disorders and infectious diseases” seem imminent, as NIH Director Dr. Francis Collins noted in a New England Journal of Medicine op-ed last year.
Plenty of significant hurdles will have to be overcome before this promise becomes a prevailing reality. For one, means of protecting patient privacy that allow for the fruitful use of tomorrow’s precision medicine findings will be needed.
While a patient might benefit greatly from a doctor’s understanding of how to cure a disease in light of a particular genetic makeup and lifestyle factors, that same information could prove to be dangerous in the hands of an insurer, an employer, or the world at large.
Standards and regulations like the longstanding “Common Rule” that governs many research trials will also need to be adjusted. Patients with rare genetic conditions and other distinctive features might be able to provide benefit to researchers, and thereby to others if they are allowed to do so.
Costs, too, will be an important factor, as tailoring a therapy to a given person’s unique characteristics is not likely to be inexpensive.
Above all else stands the need for more data and more effective tools for analyzing it, two challenges that are now receiving plenty of attention.
As even more powerful conclusions about how to care for patients in truly precise ways become clear, means of solving the associated problems will likely become so, as well.
“Our DNA, our environments, and our lifestyle choices are the three major predictors of our health.” – Donna Arnett, Dean of the University of Kentucky College of Public Health
As Donna Arnett, Dean of the University of Kentucky College of Public Health, shared, “our DNA, our environments, and our lifestyle choices are the three major predictors of our health,” and advancements that account for these fundamental facts in precise, effective ways can pay off.
