Our current medical system is based on a “one-size-fits-all” standard of care; an approach that works by determining what the best course of treatment or prevention is for the average person, and then prescribing that treatment to everyone affected by the same condition, regardless of what other differences might separate them. Necessarily based on broad population averages, the system is restricted by the limits of our understanding about the different ways in which people develop disease and respond to treatment. However, up until now it’s been the best we could do with the knowledge we had.
Today, this treatment model is changing thanks to our growing understanding of genetics and genomics, and of how they drive individual health, disease, and drug responses. This new knowledge heralds a new era of personalized medicine (also known as genomic medicine, individualized medicine, or precision medicine): an approach that emphasizes, rather than ignores, the ways in which your disease risks are different and unique, thereby moving us ever closer to predictable and precise health care that is customized for each individual.
Personalized medicine still has a long way to go, and there is a lot of work to do to prove that it is indeed better and more effective than the traditional approach. Nevertheless, it’s not difficult to see the many benefits that fully developed personalized medicine could offer. These include the following:
A shift in emphasis from reaction to prevention
Personalized medicine uses genetic markers to determine the risk or presence of a disease before the appearance of clinical signs and symptoms. This means that doctors can shift their treatment focus from reacting to a disease that may already be well advanced to concentrating on prevention or early intervention, which can be life-saving in many cases. A famous recent example of preventative action based on genetic information is the double mastectomy undergone by actress Angeline Jolie after she learned she was a carrier of BRCA1, a genetic marker associated with a 65% risk of breast cancer.
Reduced trial-and-error prescribing
Patients do not always respond to or benefit from the first drug they receive during their treatment. According to a 2001 article in Clinical Trends in Molecular Medicine, 40% of asthma patients, 43% of diabetic patients, and 50% of arthritis patients will not respond to their initial treatment. Previously, physicians have had no option but to continue prescribing different treatments until they discover one that suits the patient; however, genetic screening helps avoid this frustrating and costly practice by allowing physicians to choose the best currently available option for therapy the first time.
Fewer adverse drug reactions
Studies show that just over 5% of hospital admissions are linked with adverse drug reactions (ADRs). Such reactions are typically the result of genetic variants that cause people to metabolize drugs at a rate that is either faster than normal, which eliminates the drug before it has had a chance to work, or slower than normal, which can lead to “overdose toxicity.” Consequences of ADRs can range from unpleasant to fatal. However, under personalized medicine, genetic markers can be used to help facilitate safer and more effective dosing, and thus avoid serious and possible fatal reactions.
Increased patient adherence to treatment
Personalized medicine can also bring about indirect benefits in the form of improvements in patient behavior. A significant proportion of adverse health effects, as well as increased health care costs, is a direct result of patient non-compliance with treatment—in other words, patients who do not correctly follow their treatment steps, either because of undesirable side effects or because they do not feel that the treatment is having any benefit. If personalized therapies are better able to treat illness effectively and reduce potential side effects, patients may be more likely to properly comply with their treatments. This is especially important in the cases of such chronic diseases as diabetes and asthma, two conditions that are commonly aggravated by patient non-compliance.
Reduced need for invasive procedures
For some health conditions, personalized medicine may lead to fewer invasive and uncomfortable tests. Heart transplant recipients, for example, must currently undergo frequent biopsies for up to several years after the transplant to ensure that the body does not reject the new organ. To obtain the biopsy, doctors insert a tube into a vein in the neck, and then thread it through to the heart—a highly invasive and painful procedure. However, a new molecular diagnostic test called Allomap is currently in development. It simply requires a blood sample to detect whether an individual’s immune system is at risk for rejection.
Greater control over health care costs
The potential of personalized medical care to reduce global health care costs is significant. Integrating personalized medicine into the fabric of our present health care system could have the effect of addressing and resolving a number of deeply embedded problems and inefficiencies, including trial-and-error prescribing, hospitalizations caused by adverse drug reactions, reactive treatments, and late diagnoses.