The rise of precision health care shows that one cure might not fit all

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BlaineChildress

I’m different. And so are you.

We enjoy our uniqueness. Some outwardly express their individual style with fashion or hair color.

Health care, however, tends to treat us as one population using clinical study averages and symptoms. Your physician may know your first name and recent medical history, but then recommend a generic treatment. Such a therapeutic response may produce disappointing results, or worse, unintended consequences such as an adverse drug reaction. If one cholesterol medication does not work, another is chosen. If a tumor is found and the first chemotherapeutic agent doesn’t work, doctors and patients move on to the next one — an unfair exaggeration, perhaps, but nevertheless imprecise trial and error.

innovate-sidebarPersonalized care, on the other hand, recognizes that every patient has a unique genetic profile and physiology, and deserves a treatment strategy that reflects individuality. In the case of pharmaceuticals, it recognizes that the right person should receive the right drug, at the right time and in the right dosage. Precision matching is important since about half of existing prescriptions do not work, causing frustration, continued illness and lost time and money. Individual care is also important, because precision medicine is growing at about 13-15 percent annually. It is big business, expected to exceed $45 billion in four years, mostly in specialized diagnostics, individually crafted biomedical devices and tailored prescriptions.

This medical strategy uses molecular biology technologies such as pharmacogenomics, biomarkers, proteomics and genomic profiling to provide a precise diagnosis. It increasingly relies on “big data” to shrink analyses from days to seconds. With health care, every second counts and costs. It is estimated precision health care could save $750 billion every year. It is growing rapidly, because human genome sequencing is about 300,000 times less expensive than it was 15 years ago.

Pharmacogenomics is a class of precision medicine that employs biomarkers to provide a sort of designer drug. Genetic tests and protein classifications can help determine a tailored drug treatment. More than 100 drugs are classified with respect to biomarkers that may be linked to segments of one’s own genetic material.

In the case of anticoagulants, the goal is to prescribe a dosage that could prevent internal clotting but not result in hemorrhaging. Typically, a person’s weight and age are considered, but genomic testing now offers the possibility of targeted treatment. Using a blood sample or cells swabbed from the cheek, a genomic report can provide a better determination of a safe, effective treatment, instead of beginning with an assumed dosage of a medication like Warfarin. While still in development, targeted prescriptions will soon become the standard tool of physicians.

Our local community is engaged. In 2015, Greenville Health System partnered with Selah Genomics to develop advanced diagnostic testing, thereby helping clinicians identify key genetic biomarkers. A molecular profile is made available to the clinical team through a protected web portal, with the aim of precise tissue classification and cancer type. According to Selah, individual profiling can assist practitioners by providing an understanding of how a person metabolizes a candidate drug and how they may respond to it. In the case of tumors in the colon, breast or lung tissues, the output from Selah’s PrecisionPath technology can guide the patient and oncologist to the most effective individual treatment. This leading-edge technology is anticipated to serve as an important component of the upcoming Innovations in Medical Economic Development (IMED) vision. IMED campus is a bold research initiative that promises new high-knowledge jobs for the region (think ICAR).

Genomic data is the epicenter of personalized medicine. It is spawning innovations that may transform how we prevent and approach illnesses. New challenges are attached to such big data sciences, especially privacy and ownership. But the breakthroughs will be transformative, and the expectation is that the individual is the rightful owner of data about her or his genetic makeup instead of the lab or physician. It is our personal trade secret.

If you get sick, knowing your molecular makeup can become the lens through which a personal treatment pathway is charted. Lifestyle, age and fitness all influence the clinical response to medication, but so do genes. Precision health care is here, because average just isn’t good enough.

 

By James Tourtellotte, photo editor of CBP Today, Public Domain, via WikiMedia Commons 

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