Moving from Population Medicine to Personalized Medicine

Health Technology Assisting the Move from Population Medicine to Personalized Medicine

In the United States, despite high hopes, our health-care system still generally operates as a one-size-fits-all model. Some refer to this as a population model. This paradigm suggests that in the majority of people, an ailment — be it a common cold or a cancer — has a common predicted trajectory and most people will benefit from a homogeneous course of treatment. If a particular treatment does not work, then the second-most likely successful treatment plan is prescribed.

This continues until the ailment is relieved. Treatments are set based on available population statistics, and trial and error is used until the patient is well. In this model of medicine, personal characteristics, risk factors, lifestyle choices and genetics are rarely considered. Therefore, the treatment approach will not be ideal in all cases, failing those who do not fit with “average” parameters.

Personalized medicine, on the other hand, advocates the customization of health care. It aims to prevent diseases, as well as tailor treatments to an individual so a disease or illness can be targeted in a way that promises the highest chance of success based on the attributes of the individual. An underlying assumption of this approach is personalized medicine (PM) takes into account that drugs and interventions will have varying efficacy based on the person being treated.

Health Technology in the Age of Genomics

Now that science possesses a complete map of all the genes in the body, personalized medicine is manifesting as a reality.

The National Human Genome Research Institute emphasizes that personalized medicine involves the use of a patient’s genetic profile to guide decisions regarding prevention, diagnosis and treatment. Modern health technology now allows for the individual’s genome to be examined in order to detect specific characteristics or abnormalities.

Angelina Jolie’s public disclosure about carrying a BRCA1 gene mutation — which puts her at high risk of breast cancer and ovarian cancer —brought some of these concepts to the public’s attention. Making choices based on gene type might not yet be the norm in everyday health-care practice, but it is becoming more prevalent.

Oncology is an area of medicine where DNA sequencing technology has a lot of potential. For example, for lung cancer, there are many personalized treatment options now available based on different lung cancer biomarkers. If there is a medical indication, genetic tests can often be covered by the insurance, especially if there is an FDA-approved drug or treatment that is tied to a genetic mutation.

Recently, researchers have also used DNA sequencing to establish the connection between bovine leukemia virus (BLV) and breast cancer. It was previously believed that this cattle virus cannot infect humans. However, a study conducted by the University of California, Berkeley, and the University of New South Wales, Sydney, showed that BLV can be present in human tissue 3 to 10 years before cancer gets diagnosed, indicating a strong correlation.

Genome-driven medical care is becoming increasingly utilized due to the development of next generation sequencing (NGS) technologies.

According to The National Human Genome Research Institute, whole genome sequencing can now be performed in less than 24 hours for under $1,000. The genetic services have become more accurate and affordable and are now used in both public and private institutions. However, numerous challenges still need to be tackled. For instance, many doctors may lack training opportunities and are unfamiliar with the emerging technologies. Some experts also warn that there needs to be a balance between hope and hype and that ethical issues should be strictly monitored.

A New Organ from Your Own Cells

Perhaps one of the most sensational innovations in the area of personalized medicine is printing 3D organs from one’s own cells.

It is predicted that in about 10 to 15 years, organs will routinely be produced from cells harvested from patients themselves using 3D bioprinting technology. In the future, organ transplantations might eventually be replaced by customized organ growing.

Anthony Atala, M.D., the Director of the Wake Forest Institute for Regenerative Medicine, has already demonstrated that transplantable kidneys can be produced using such a technique, helping to curb a crisis resulting from organ shortage. Organovo, a company working on personalized bioprinted human tissue, has so far produced 3D liver models that stay functional and stable for up to 28 days and can be used for drug testing, offering an alternative to animal and in vitro experiments. At the end of last year, Chinese scientists successfully printed a part of the heart’s left atrium (left atrial appendage). Occlusion of this part can play a role in preventing stroke in patients with atrial fibrillation. It appears that 3D technology can offer an improved presentation of an individual’s left atrial appendage compared to conventional imaging methods. This is essential for surgeons as they need an accurate preoperative reference before they start with the occlusion procedure.

Mobile Technology and Personalized Medicine

Eric Topol, the Director and Professor of Genomics at Scripps Translational Science Institute, describes the now ubiquitous smartphones as the hub of future medicine. Mobile phones and mobile peripherals can be used as biosensors — measuring blood pressure, heart rhythm, blood sugar levels and even brain waves — as well as functioning as a personal scanner such as an otoscope or ultrasound. People can now perform many measurements by themselves, when they want and where it is most convenient for them. They can view and interpret their data without having to visit the doctor, making health care increasingly more personal and individual-based.

Sources

Bloss CT, Wineinger NE, Peters M,...Topol EJ. A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors. PeerJ; 2016, 4:e1554

Buehring G, Shen H, Schwartz D, Lawson J. Bovine leukemia virus linked to breast cancer in Australian women and identified before breast cancer development. Plos ONE, 2017; 12(6):1-12

Hayes D, Markus H, Leslie R, Topol E. Personalized medicine: Risk prediction, targeted therapies and mobile health technology. BMC Medicine, 2014; 12(1).

Kamps R, Brandão R, Romano A, et al. Next-Generation Sequencing in Oncology: Genetic Diagnosis, Risk Prediction and Cancer Classification. International Journal of Molecular Sciences, 2017;18 (2):38-57.

Peng L, Rijing L, Yan Z, Yingfeng L, Xiaoming T, Yanzhen C. The Value of 3D Printing Models of Left Atrial Appendage Using Real-Time 3D Transesophageal Echocardiographic Data in Left Atrial Appendage Occlusion: Applications toward an Era of Truly Personalized Medicine. Cardiology, 2016; 135(4):255-261.

Continue Reading