Precision Medicine: One Size Does NOT Fit All
It’s a cold, sunny weekend afternoon and I’m taking a moment after making the kids lunch to take a look at the alumni magazine from my medical school. It’s always fun for me to read about medical topics that are NOT in my lane of pediatrics/pediatric emergency medicine, because while I’m not totally familiar with the ins and outs of the exact medical practice, I read this stuff with the perspective of a clinician, so it doesn’t always come across as a completely foreign language. And now with the sun warm on my back and a sip of bubbly sparkling water cool on my throat, I’m reading about PRECISION MEDICINE. Just the name alone gets my attention quickly. Sounds groovy.
- Is it a new fancy tool for the operating room that can make a microscopic incision in some hard to reach place in the brain?
- Is it a new lab technique that will advance the search for the cure for cancer?
- Is it an intricate machine that will generate EXACT medicine doses based on a person’s weight?
Well, turns out it’s a bit of all of those and none of those.
PRECISION MEDICINE, according to the National Institutes of Health, is an emerging approach to disease treatment and prevention that takes into account the individual as well as what’s known about the disease process itself. And by individual, I mean that one single person’s genetics, environment and lifestyle are all included in an approach to therapy. So in essence- saying goodbye to “one size fits all” medicine.
Kinda cool, huh? I love the idea of this—that any particular illness I might get could require a different therapy than someone else with the same disease. But how does this actually work?
The concept isn’t really totally new.
The example of blood typing is often brought up to describe precision medicine in a familiar way- each individual has a specific blood type, and so if you need a blood transfusion, you determine your blood type and get exactly the right type for you. What IS new, however, is that advancements made in the field of genetics combined with computational tools with cool predictive modeling programs and large biologic databases can provide for a practice of medicine that is, for lack of a better word, more PRECISE.
Here’s a simple example of where this is going from my own life this week.
I went to see my primary care physician for the first time in about FOREVER and I got my lipid profile (cholesterol, HDL, all that stuff) checked. The cholesterol number and each lipid index are helpful, but at the end of the day what I really want to know is what my risk of heart disease is. Well, seek and ye shall find. My swell doctor fired up a heart disease risk calculator program on his laptop that takes into account my age, my cholesterol (a little high, annoyingly; good lord I love butter), my systolic blood pressure (the top number), if I smoke (big fat NO, for the record) and with a simple click on the mouse my own personal 10 year risk was calculated. Not only that, but this program could also adjust the risk if I did something like take a cholesterol-lowering medicine. This is helpful because I saw that while my overall risk is low, adding a medicine didn’t make much of a difference AT ALL in that overall risk, so probably not the right move for me at this time. But, from looking at my total cholesterol alone one might draw the conclusion that:
- Jeez, that girl needs to STOP IT ALREADY with the butter, and
- She should get on some cholesterol lowering meds. Pronto.
And I’m not going to do either one, because I’ve taken into account my whole profile.
It’s important to know about this “coming together” of science, medicine, and technology because I think we’re on the brink of many individual breakthroughs in medicine. When our children are adults, they will probably have their own genome on a thumb drive in the glove box of their car, and will sync up their recent vital sign data captured on their smartphone at the sign-in kiosk when they go to the doctor. Keeping up with the rapid advances is going to be tough, but critical.
So what’s coming down the pike for precision medicine? Here are a few more examples:
Growing replacement tissue.
Yep. I’m not just talking about using stem cells. This involves combining biology with engineering to repair and create tissues like blood vessels, grown from cells differentiated on man-made scaffolding. For those with heart & vascular disease, this could essentially rebuild and replace a blood vessel that’s filled with plaque. This stuff slays me.
Molecular profiling of microorganisms.
I love that title, and molecular profiling of microorganisms means identifying the exact DNA sequence of microbes that can help to customize antibiotic therapy, and do it quickly, like during the course of an emergency department visit. Ultimately, it will help us to know exactly which antibiotic works against each specific microbe and get ya feelin’ better ASAP, not to mention aid in the fight against antibiotic resistance. Boom!
Not everyone responds the same way to foods, and therefore researchers are developing computerized algorithms that take into account individuals’ various data points like blood sugar, and then generate a specific diet that has potential to help people with illnesses such as diabetes who have had difficulty controlling their glucose. I can’t resist making the editorial comment that when they come up with the diet that helps ‘slim down the middle’, I’ll be first in line. All kidding aside, with compelling evidence of the importance of what we eat in so many medical conditions, the implications of optimizing dietary intake for health and wellness are broad reaching.
So, there you go, and #nowyouknow.
Pretty impressive, don’t you think? If you’re at all like me you sort of half-way pay attention to the futuristic sounding news reports of emerging scientific breakthroughs that involve computer models, artificial intelligence, and stories like that. Now that we’ve had a brief introduction to precision medicine, I hope we’ll all tune in a little closer. We need to.