Precision Medicine – Improving Lives

As healthcare advances with more information about what affects our risks of certain diseases, a new approach to medical care could more effectively prevent or treat conditions, to potentially extend both health and longevity. It’s called precision medicine, also known as personalized medicine, and it’s an emerging medical approach that considers individual differences in our genetic makeup, metabolism, and other factors to determine which treatment strategies might work better for certain people.

Key takeaways:
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    Precision medicine uses a patient’s distinct, personal data to provide a customized solution to a disease.
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    This approach incorporates our genetics, environment, and other health factors so healthcare providers can better define, understand, and treat us.
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    Many conditions and diseases might be effectively treated by this approach as more data is collected and studied.

What is precision medicine?

Alex Dimitriu, MD, double board-certified in Psychiatry and Sleep Medicine and founder of Menlo Park Psychiatry & Sleep Medicine and BrainfoodMD, told Healthnews that Precision medicine is the use of specific biological or genetic information to provide a “customized solution” to a patient.

“It involves the use of genetic testing, biomarkers, and other tests to determine the optimal treatment modality that may be unique to an individual, rather than a blanket, ‘one size fits all,’ treatment,” he continued.

How might precision medicine shape the future of healthcare?

Alpesh Amin, MD, MBA, Executive Director, Hospital Medicine, co-director, and medical director at the Institute for Precision Health at UCI Health, in California, emphasized how critical it is to collect genetic data for effective precision medicine treatment.

“Getting people’s biological blueprints – genetic sequencing, heritable modifications of DNA (epigenetics) and omics, which include sequence RNA and cellular building blocks determined by DNA and RNA (transcriptomics), proteins (proteomics), and profile metabolites (metabolomics) – into health records would be a huge precision health achievement,” he said.

Will allow a ‘more sophisticated’ approach to treatment

According to Amin, precision health should allow for “more sophisticated” approaches to disease for patients.

“Approaches that incorporate their genetics, environment, and other health factors so that clinicians can better define, understand, and treat diseases,” he said.

Amin noted that the potential impact on clinical trials could be “revolutionary.”

Harnessing the power of big data

“Patient data is used alongside computer algorithms, predictive modeling, and artificial intelligence to help clinicians and patients in making individualized treatment and health decisions,” he said.

Amin explained that once these decisions are made, outcomes are fed back into the system to help better inform the next decision and all subsequent patients.

“Precision Health's aim is to use the power of big data to create a healthier individual and society,” he said.

Benefits of psychiatry and sleep medicine

Dimitriu pointed out that psychiatry and sleep medicine already have several genetic tests available to determine drug sensitivity and responses.

“However the applications of these are still limited,” he said. “As in most cases, careful clinical application and monitoring are [currently] more effective than the genetic test.”

As genetic tests become more advanced, Dimitriu believes we may start to see more useful applications.

“We occasionally use genetic testing to guide future treatment directions,” he said. “Close and detailed monitoring of sleep is also essential to positive outcomes, as sleep is perhaps the most important and objective biomarker of mental health.”

Saving vision with a personalized approach

Dr. Brian Boxer Wachler, MD, ophthalmologist and medical reviewer at All About Vision, noted that precision medicine could advance the treatment of serious eye conditions like retinitis pigmentosa (RP).

“This is a group of rare eye diseases that affect the retina (light-sensitive tissue in the eye),’ he explained.

RP causes cells in the retina to break down, resulting in vision loss.

Recent studies have shown that the condition could be treated by using patients’ stem cells, which can recreate functional tissue. However, more research is needed for this to become an effective treatment option.

“There are several studies investigating these treatments,” confirmed Boxer Wachler. “So it’s likely years before we know if these treatments are shown to be safe and effective in humans and ready for people with these conditions to be treated.”

Longevity medicine

According to a recent editorial in The Lancet, longevity medicine is advanced personalized preventive medicine based on “deep biomarkers” of aging and longevity that is a rapidly growing field.

The authors caution that improvements in education in accessibility will be needed to realize the promise of this emerging specialty.

They emphasize that healthcare providers will need “customized courses” on the most recent advances in longevity medicine and how to implement this knowledge in their practices.

An issue that must be addressed is patient access.

“Patients have insufficient access to the health-care providers who have been adequately trained in longevity medicine and can manage a patient from a longevity medicine standpoint,” the authors wrote.

Many conditions and illnesses could benefit from this approach

Asked which diseases might benefit from precision medicine, Amin said they include cancer, Alzheimer’s, and Parkinson’s, “along with many other diseases.”

He said that researchers and clinicians at UCI Health are already doing “formidable work” using data like genetics and omics in precision medicine-type approaches.

“For example, breast cancer patients who test positive for a protein called human epidermal growth factor receptor 2 (HER2) receive treatments that specifically target HER2,” Amin said.

He added that the treatments are now so effective that the prognosis for HER2-positive breast cancer has improved drastically.

Amin said UCI Health is currently working with the National Institutes of Health (NIH) to gather important data that can be used to advance precision medicine treatments.

The ‘All of Us’ project

“Since 2017, volunteers have signed up to have their medical records, gene profiles, metabolites (chemical makeup), microorganisms in and on the body, environmental and lifestyle data, and even information from personal devices like Fitbit – used as part of the National Institutes of Health’s All of Us project,” Amin said.

According to the NIH, this project is an attempt to build one of the most diverse health databases in history.

Amin said measures are taken to protect the privacy of those who share their data.

“The NIH has partnered with leading experts in privacy, bioethics, civil liberties, and technology,” he confirmed. “All research data is de-identified. This means that names, addresses, and other identifying information are removed.”