There was a time when modern medicine was primitive. There were no antibiotics, so every infection took its own course, leading to decline in health. Hypertension and diabetes were largely untreatable. X-ray was new and remedies had changed but little from mediaeval times. No one ever embarked on the goodness of preventative treatment, not to speak of predictive medicine, beyond taking a distasteful cod liver oil capsule.
During the last one hundred years, modern medicine has undergone a ‘sea change.’ Just think of it — an ever-expanding repertoire of medicines, high-tech procedures, therapies and reams of clinical data to employ when one gets sick. Yet, modern medicine remained complete — notwithstanding therapeutic advance.
Things are now a-changin’ thanks to the integration of all such advances — from how a person's diet interacts with one’s unique genetic profile to how environment pollutants affect our thinking, not to speak of preventative medical approaches in health and wellness. The big perestroika has begun and it is poised to not just change, but also transform healthcare for a growing number of people in the near future.
Welcome to a whole new world of personalised, or bespoke, medicine.
Personalised medicine is, in essence, tailored or customised medical treatment; it treats while keeping in mind the unique, individual characteristics of each patient, which are as distinct as one’s fingerprint or signature. It also includes scientific breakthroughs in our understanding of how a person’s unique molecular and genetic profile makes them susceptible to certain illnesses. Personalised medicine expands our ability to envisage medical treatments that would not only be effective, but also safe for each patient, while excluding treatments that may not provide such objectives.
Personalised medicine is, in simple terms, the use of new methods of molecular scrutiny. It is keyed to help better manage an individual or patient’s illness or genetic tendency toward a particular illness, or a group of diseases. In so doing, it aims to achieve optimal therapeutic outcomes by helping both clinicians and patients choose a disease management approach that is likely to work best in the context of the patient’s unique genetic and environmental summary. Or, in other words, accurately diagnose diseases and their sub-types, while prescribing the best type and dose of medication most suited to the given patient.
Personalised medicine is not rocket science — it is, in essence, an extension of traditional approaches to understanding and treating disease. What ‘jazzes-up’ the therapeutic fulcrum of personalised medicine are tools that are more precise. This is what that also offers clinicians better insights to selecting a therapy or treatment protocol based on a patient's molecular profile. Such a patient-specific methodology, as has been practiced for long in certain complementary and alternative [CAM] medical approaches, not only curtails harmful side-effects, but it also leads to more successful outcomes, including reduced costs in comparison to the current ‘trial-and-error’ approach to treatment.
It is still early days, but the fact remains that personalised medicine has changed the ‘old’ way of how we all thought of, about, or identified, and managed health issues. As personalised medicine increasingly bids fair to an exciting journey in terms of clinical research and patient care, its impact will only further expand our understanding of medical technology.
What personalised medicine has done is bring about a paradigm shift in our thinking about people in general and also specifically. Like how we all vary from one another — of what we eat, what others eat, how we react or take stress, or experience health issues when exposed to environmental factors. It is agreed that such variations play a role in health and disease; it is also being incrementally accepted that certain natural variations found in our DNA could influence our risk of developing a certain disease and/or how well we could respond to a particular medicine.
All of us are unique individuals, perhaps with the exemption of identical twins, albeit the genomes are unique in them, no less. While we are genetically similar, there are small differences in our DNA that are unique — this also make us distinctive in terms of health, disease and our response to certain medicinal treatments.
Personalised medicine is poised to ‘tap’ natural variations found in our genes that may play a role in our risk of getting or not getting certain illnesses, along with numerous external factors, such as our environment, diet and exercise. Variations in DNA can, likewise, lead to differences in how medications are absorbed, metabolised and used by the body. The understanding of such genetic variations and their interactions with environmental factors are elements that will help personalised medicine clinicians to produce better diagnostics and drugs and/or better select treatments and dosages based on individual needs — not as just ‘fixing’ a pill, or two, as is the present-day conventional medical practice.
It is established that a majority of genes function precisely as intended. This gives rise to proteins that play a significant role in biological processes, while allowing or helping an individual to grow, adapt and live in their environment. It is only in certain unusual situations, such as a single mutated or malfunctioning gene, that our applecart is disturbed. This leads to distinct genetic diseases or syndromes, such as sickle cell anaemia and cystic fibrosis. In like manner, multiple genes acting together can impact the development of a host of common and complex diseases, including our response to medications used to treat them.
New advances will revolutionise bespoke medical treatment with the inclusion of drug therapy as well as recommendations for lifestyle changes to manage, delay the onset of disease and also reduce its impact. Not surprisingly, the emergence of new diagnostic and prognostic tools has already ‘upped’ our ability to predict likely outcomes of drug therapy. In like manner, the expanded use of biomarkers — biological molecules that are associated with a particular disease state — has resulted in more focused and targeted drug development.
To cull a few examples. Molecular testing is being expansively used today to identify breast cancer and colon cancer patients who are likely to benefit from new treatments and also pre-empt recurrences. A genetic test, likewise, for an inherited heart condition is helping clinicians to determine which course of treatment would maximise benefit and minimise serious side-effects, while bringing about effective curative outcomes.
Such complexities exist for asthma and other disorders. This is precisely where molecular analysis of biomarkers can help us to identify sub-types within a disease, while enabling the clinician to monitor their progression, select appropriate medications, measure treatment outcomes and patients’ response. Future advances may make biomarkers affordable and also feasible for clinicians to screen patients for relevant molecular variations prior to prescribing a particular medication.
It is already clear that personalised medicine promises three strategic benefits: 1] in terms of preventative medicine, personalised medicine will improve the ability to identify which individuals are predisposed to develop a particular condition — this will help to formulate interventions that would prevent, delay its onset and also reduce its impact; 2] a better understanding of genetic variations could help scientists identify new disease subgroups or their associated molecular pathways and design drugs to target them. This could also help select patients for inclusion, or exclusion, in late stage clinical trials; and, 3] predict the best dosage schedule or a combination of drugs for a particular individual or patient.
Yet, not everything is hunky-dory for personalised medicine. Critics of personalised medicine believe that the whole idea is too much of a hoopla, or overhyped razzamatazz. Proponents argue that when it comes to managing our own health, many of us are used to the idea of taking a ‘one-size-fits-all’ approach, be it medicines, supplements, diets and diagnoses. This may be wrong. What works, as they put it, for one may be a gaffe for another. As Award-winning oncologist and medical technology innovator Dr David B Agus, author of the groundbreaking book, The End of Illness, says, each patient’s individual risk-factors are based on one’s DNA, the environment and a preventative lifestyle plan in response. To cull an example, Dr Agus asks, “How is your sense of smell?” and “Is your ring finger longer than your middle finger?” He explains with statistics-backed guidelines that moving and walking regularly is mandatory, because exercising and then sitting is equivalent to smoking cigarettes, while eating and sleeping at consistent hours is imperative, because irregularity causes inflammation.
The inference is simple — we should all understand our physiology and ‘quiz’ doctors with the thorough, exploratory frame of mind of a gadget buyer. This holds the key to ‘making’ medicine ‘personal,’ more humane, effective and safe, while keeping in mind the individual in us all as unique, the sum of the whole, and not just composed of parts.