Custom furniture based on our individual style preference. Custom houses constructed with each detail personalized. Tailored suits that fit our body to the inch. Streaming services that predict our next movie or TV show preference.
In a world where tailoring everything to the specific needs of the consumer is mainstream, what would it look like if we could personalize our medicine to this degree? That’s the premise behind the latest trending model from the healthcare industry called precision medicine or personalized medicine.
How does precision medicine work? What challenges does it face now and in the future? Can precision medicine be applied to underserved or rural areas? Let’s break down these questions and more in our newest blog post of 2018.
Precision Medicine 101
Precision medicine (PM) is a medical model that proposes the customization of healthcare, with medical decisions, treatments, practices, or products being tailored to the individual patients taking into account their genes, environment, and particular lifestyle. Precision medicine often uses diagnostic testing for selection of the most appropriate and optimal therapies based on the patient’s genetic content, molecular or cellular analysis. This model allows doctors and researchers to more accurately predict which treatments and prevention strategies will work for particular people, directly juxtaposed against the “one-size-fits-all” approach used in some disease treatment.
Although precision medicine is a relatively new term to the healthcare space, the concept has been around for many years. When a patient needs a blood transfusion, the recipient’s blood type is matched to an appropriate donor to reduce risk of complications. PM takes that concept and expands to new depths researchers are just now discovering and will continue to discover in the coming years. Before, it was impossible to target medicine to a specific patient’s individual genetic makeup, but with the latest advancements in medical research and technology that is quickly becoming a reality.
At the moment, precision medicine is mainly used for treatments in the following areas:
- Cancer diagnosis and treatment
- Diagnosing and preventing genetic disease
- The suitability of medicines
- Population health data
One of the most famous examples and early prototypes for precision medicine was the case of Eric Dishman. Dishman was diagnosed with a rare type of kidney cancer and underwent rounds and rounds of treatment over the course of 20+ years without success. After he was able to receive his gene mapping, Dishman’s physicians learned his previous treatments were unlikely to have benefitted him, and actually directed him toward a clinical trial and a kidney transplant. After that, he was declared cancer free. Now, Dishman is the director of the National Institute of Health’s Precision Medicine Initiative Cohort Program, recently renamed to All of Us Research Program, which advocates for increased awareness and for scaling PM programs to eventually be accessible to the entire U.S. population.
Former President Obama also launched his Precision Medicine Initiative in 2015 with a $215 million investment to pioneer a “a new model of patient-powered research that promises to accelerate biomedical discoveries and provide clinicians with new tools, knowledge, and therapies to select which treatments will work best for which patients.” This initiative helped put precision medicine “on the map” and pushed for greater investment in its development, clinical trials, and scope.
How Does Precision Medicine Actually Work?
An excerpt from this Popular Science article explains how PM works at the genetic level and why it’s so powerful:
“On their most basic level, cancers are diseases in which normal cells grow more quickly than they die. Genes regulate this cycle of growth and death. Mutations in these genes can affect a person’s cancer risk, but they can end up in the genome in different ways….Acquired mutations are the ones that are added to your genome after you are conceived; women with HER2-positive breast cancer (about one fifth of all breast cancers) weren’t born with that mutation: It developed over time due to environmental and lifestyle factors….Precision medicine—also known as personalized medicine or individualized medicine—mostly targets these acquired mutations because those are what make the cancerous cells different from the other cells in your body… Once they’ve identified the mutations driving the cancer, doctors can prescribe drugs that target and destroy only the cells with that mutation.”
-Alexandra Ossola, “Everything You Need to Know About Precision Medicine”- Popular Science
Patients Interested in PM
Even though precision medicine has its own federal initiative and is well-known in the medical research community, recent studies are showing patients are unaware of precision medicine, but are excited about the opportunity it could open up for their own personal care once educated on the topic.
A recent survey of more than 1,000 patients gathered data on general public attitudes toward precision medicine:
- Two-thirds (66%) said they had never heard of either “precision medicine” or “personalized medicine” before
- 82% said they were interested in more information
- When provided with more information, 67% viewed the possibilities presented with precision medicine favorably
However, patients also indicated in the same survey concern over affordability of precision medicine testing and treatments:
- 62% said it was a “major concern” whether genomics testing would be covered by their insurance
- 52% worried results from testing would be used to deny coverage for treatments they want or need
It’s no surprise as every other industry moves toward ICB-personalized service and consumerism, the healthcare industry is similarly moving toward the same model while taking advantage of the latest genetic testing and technology to do so; however, concerns over payment models for PM testing and treatment is a challenge the industry will need to tackle. As the healthcare industry moves to value-based care, these payment models will need to be developed since PM doesn’t neatly fit into the current fee-for-service system approach.
Improving Outcomes & Cutting Costs
Precision medicine may be relatively unheard-of to the general population, but it’s proving its power through improved outcomes and cost savings for health systems and patients. For example, Intermountain Healthcare’s precision oncology program led to $733 in savings per week per patient, and survival rates improved with patients using targeted therapies, living for 51.7 weeks after diagnosis compared to 25.8 weeks for patients not enrolled in the program. Additionally, a meta-analysis of hundreds of clinical trials involving thousands of patients at the UCSD School of Medicine using PM approaches found improved response and longer periods of disease remission. Another study from the Indiana University Health Precision Genomics Program, which conducted an analysis of their first 101 patients enrolled in the PM program, found “43.2% of those patients who received genomic-guided therapy had improved progression-free survival when compared with their own prior therapy versus only 5.3% of those who did not receive genomic-guided therapy.”
Challenges & Concerns About PM
As with any new model in the healthcare space, challenges in implementation and concerns over the data of precision medicine are making it difficult for health systems to roll out PM programs of their own.
Some of the those challenges include:
- Fears over how data collected in PM testing will be use
- How PM data will be protected from cybersecurity attacks
- Lack of physician engagement around genomics
- The need for new tech tools
- Getting insurance payers to cover services
While each health system is different, plenty of systems around the country have overcome these hurdles using a variety of tactics. For physician engagement and provider adoption, systems are bringing the genomic testing in-house rather than relying on outside programs in order to reduce outsourcing fees, provide more control and access to the data, help lower costs, and gain tighter control of the PM program. For example, Stanford built their own genomic test to prevent outsourcing and Providence St. Joseph began conducting genomic tests internally to provide easier physician access to the data.
For cybersecurity concerns, it’s critical health systems have a robust cybersecurity protection plan with multiple protocols to protect and safeguard patient’s data. See our previous posts on monitoring, supporting, and protecting your networks from cyber security threats.
Some opponents also feel the cost and scope of precision medicine can’t justify its outcomes, which can often only help a tiny portion of the population. Others also cite the recorded risk of misinformation from DNA testing and improper analysis leading to unnecessary, and in some cases harmful, treatments as a great risk and drawback of PM. Each of these concerns will have to be vetted and worked through in the PM industry to prevent any harmful outcomes.
Applying PM to Community & Rural Settings
Think precision medicine is too advanced or resource-heavy to be applied in community-based or rural areas? Think again. Although it is challenging to bring precision medicine clinical trials from academic cancer centers to the community setting, it is not impossible. Combined with telemedicine systems, precision medicine can be implemented to rural and underserved areas across the country with the right resources, staffing, and coordination. One medical system was able to enroll two patients from Lincolnton, North Carolina- a town with a population around 10,000- into the TAPUR (Target Agent Profiling Utilization Registry) for a precision medicine study aimed at testing the safety of USDA-approved targeted drugs for late-stage cancer patients with potential actionable genomic alterations. As more and more health systems adopt PM programs, they must actively take on the challenge of figuring out cost-effective ways of rolling them out to rural and community areas so everyone can benefit from precision medicine in the future.
What are your thoughts on precision medicine? Do you think PM will become mainstream in the near future? Would you like to see PM incorporated into your community or rural area? Let us know in the comments below!
Additional Reading & Resources:
- National Institute of Health’s Precision Medicine Initiative Cohort Program, recently renamed to All of Us Research Program- https://allofus.nih.gov/
- Popular Science- Everything You Need to Know About Precision Medicine: https://www.popsci.com/everything-you-need-know-about-precision-medicine
- Med City News- Up close and personal: How the life science industry can outcomes through precision medicine: https://medcitynews.com/2017/07/close-personal-life-science-industry-can-improve-outcomes-precision-medicine/