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Personalized Medicine: The Evolution of Patient Care

Ashraf Amlani - Friday, December 31, 2010

As a country, Canada spends nearly $30 billion each year for prescription drugs. Take into consideration that, on average, prescribed drugs only benefit 50% of the population, one can see the need to improve the existing health care system. Most cancer drugs work in only 25% of cancer patients, while diabetes drugs work for up to 50% of patients. In addition, adverse reactions from medications can aggravate the patient’s condition, further increasing health care expenditure through emergency treatments and hospital care. Hippocrates, the father of medicine, was the first to personalize medicine when he said "Different medicines for different patients, for the sweet ones do not benefit everyone, nor do the astringent ones, nor are all the patients able to drink the same thing". And while science has made much progress through the centuries, the idea of personalizing medicine is one that holds true to this day.

Effect of prescription on a patient groupWe now know that each of us has a different genetic makeup and our genes are turned on and off based on the environment we are in. This makes us unique individuals needing medical care tailored to our system. Consider the case of Cisplatin, a common chemotherapy drug, which was given to two children at the same dose. In both cases, the cancer was eliminated, but only one of the two children experienced complete hearing loss. Dr. Collin Ross's group at BC Children Hospital studied the genetic make up of children across Canada who experienced this side effect to Cisplatin. They found that the presence of two genes, TPMT and COMT, result in a 93% chance of hearing loss in children treated with Cisplatin. This example demonstrates that knowing their patient’s genetic make up can allow doctors to accurately determine the type and dose of treatment suitable for that patient.

This is personalized medicine in action, where genetic screening and other diagnostic tests are used to tailor treatments for patients. The idea is to give “the right treatment at the right time at the right dose to the right patient”. Personalized medicine allows for a greater success rate in lowering disease progression, and reduces health care costs associated with adverse drug reactions and emergency hospitalization.

Decoding genomesOne may find it difficult to believe that a better treatment or a new technology would lower costs. Genetic testing for each patient may seem to be a great cost to the health care system, but with improvements in sequencing technology, this cost is being reduced every day. Having access to our own genomic sequence is no longer a far-fetched notion but rather a soon-to-be reality. 10 years ago the first human genome was sequenced at a cost of $2.7 billion; today the cost of genome sequencing is decreasing to almost $1000 per person, which this is the approximate cost of an MRI. 10 years from now sequencing costs are expected to be reduced furthermore. Our understanding of genes and their functions is increasing exponentially as researchers compare the genetic makeup of different populations. Genetic markers for chronic diseases, such as cancer, diabetes, and Alzheimer’s have already been identified and can be used for prevention of these diseases, which are a burden to both the patient and the health care system. Biomarker assisted diagnostics is another growing field and this technology is expected to change the way drugs are developed and the way physicians treat their patients.

iBGstar The revolution of personalized medicine has already commenced and this market is expected to grow 11% annually, becoming a $452 billion industry by 2015. Researchers are looking at targeted treatment of certain cancers based on genetic markers for cancer drugs. Perhaps the best known instance of this is the screening of tissue samples from breast cancer patients for the HER2/NEU gene, where a positive test can lead to successful treatment by Herceptin (HER2 antibody). GenomeDx is a local company in British Columbia that is screening, developing, and commercializing genome based tests to bring personalized cancer care closer to reality. Other advances in molecular diagnostics include the iBGStar™ glucose meter, which is able to connect to iPhones and allows diabetics to monitor their glucose levels. The information is stored on the phone and can be sent to the patient’s physicians for advice and treatment information. 

With the reducing cost of genome sequencing and rapid increase in new diagnostics technology, a large amount of information about an individual’s genetic profile can be readily available. However, this poses a great challenge to the current health care system if it is to incorporate personalized medicine as the model for the future. One would need to create the IT infrastructure, with right hardware and software to store the “ehealth” genomic records of patients. At the very minimum, 3 billion bases pairs of sequence data would have to be stored and analyzed for each individual. The current storage devices are not capable to store all this data generated. There are projects such HP Extreme Data Storage, a multimillion project, to keep pace with next generation sequencing technologies and personalized medicine.

An even bigger challenge is gaining a deeper understanding on the function of over 20,000 genes, how they are regulated, how they interact and how they are affected by the local environment. And while researchers are learning more about the function of these genes, it will take several years of study and integration into systems biology models to fully understand these interactions. Yet another challenge is the implementation of personalized medicine by health care practitioners. Even though 68% of parctitioner's are in favor of personalized medicine and some predictive tests are available, many doctors do not use them because of the costs associated with these tests and their lack of comfort in using genetic information to treat patients. Much effort will be needed to educate physicians about gene interactions, genetic markers and drug safety so that they become more comfortable in practicing personalized medicine. Again, computer-based applications can be created to computationally determine the correct diagnosis based on various genetic and environmental factors. Beyond this, there are other issues ranging from regulatory approvals of the targeted therapies to ethical, legal, and social implications of having access to and storing highly sensitive genetic information.

While there are significant costs and challenges associated with implementing personalized medicine, there is a lot to be gained from this model and there is a great push within the industry to advance the health care system in this direction. While it may take years to implement, the evolution of the health care system to be tailored treatments to each unique individual will be a reality in our own lifetime. British Columbia is a world leader in many areas of research and innovation, and has already started adapting to personalized medicine. Institutions like Genome BC, Genome Sciences Center, BC Cancer Agency, Centre for Drug Research & Development, DigiBC, and BC Children’s Hospital are among the many that have already taken the lead to take personalized medicine to the next level through funding, research, innovation and public awareness.





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Comments
Anonymous commented on 10-Jan-2011 05:11 PM
Check out this instant ECG iPhone app: http://www.instantecg.org/instant-ecg/

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