Precision Medicine: It’s Best Not to Get Hopes Up

Picture Credit: President Obama | 2016 | whitehouse.gov

In an ideal world, every person must receive a custom healthcare treatment that matches their biological makeup. We may not live in an ideal world today, but the latest efforts in preci­sion medicine plan on coming as close to it as possible. Despite enthusiasm for this movement, similarly grand ambitions in the past have shown that the results often come up short of the prom­ises made. Personalized medicine is a mode of healthcare where every practice and treatment is tailored specifically to each patient. The idea was to collect genetic information from all indi­viduals to create an all-encompassing database. However, personalized medicine has undergone some changes over the years and has recently re­defined itself as “precision medicine.”

Rather than creating drugs or medical devic­es that are unique to a single patient, precision medicine classifies individuals into small groups based on their susceptibility to a particular dis­ease or their response to a specific treatment. These small groups allow physicians to know what sort of care a patient needs depending on what sub-group the patient is in.

Don’t let the definition change fool you. The name change mainly aims to allow the movement to start afresh. By rebranding itself as precision medicine, the practice gains a second chance af­ter failing previously. Even with this fresh start, precision medicine is still liable to obstacles that personalized medicine stumbled over in the past. For instance, electronically recording the genome of every individual remains expensive. Collecting all that information and acquiring the technology to store it is not something to take lightly.

There are also fears regarding patient privacy concerns and legal liability. This sharing of pa­tient data can easily end badly for both the doctor and the patient. However, precision medicine has only gotten more popular since its re-branding. What makes precision medicine so revolutionary is its focus on individuals rather than on a demographic. Instead of using a one-size-fits-all approach, it takes into account individual differences from genetic makeup to personal lifestyles. The hope is that precision medicine can accelerate the creation of tailored treatments for diseas­es like cancer.

By expanding genetically-based patient trials, scientists and doctors will have much more infor­mation to work with when leading research and providing treatment. A nationwide database of patient genetic and medical information can help guide treatment and reduce uncertainty. Preci­sion medicine also attempts to ensure that drug companies spend time developing treatments for specific groups of patients. Most firms currently try to optimize profits by producing drugs that can benefit large groups of people.

While beneficial to many, this ignores the plights of those with rare medical conditions who must go extreme lengths to get proper care. Precision medicine aims to promote the creation of treatments for a wide range of diseases, common and rare.

There are countless reasons to push for preci­sion medicine. However, I am suspicious at the growing hype over precision as the next great landmark achievement in healthcare. Even with the aforementioned risks, the re-branding has succeeded spectacularly. Precision medicine has entered the forefront of national discussion and the public often views it as the bringer of a new age of healthcare.

In his final State of the Union address, President Obama announced the Precision Medicine Initiative (PMI) to push for the nation to adopt this movement, asserting, “My hope is that this becomes the foundation, the architecture, whereby 10 years from now we can look back and say we’ve revolutionized medicine.” The President asked Congress for $215 million to support the initiative. Thanks to Obama’s support, the PMI Cohort program plans on amassing a record of one million U.S. volunteers.

Despite the optimistic outlook on the issue, precision medicine is far from ideal. In addition to the costs and legal issues, there are concerns as to whether a database on genetic information would even be significantly useful. Back in 2003, scientists discovered that even after mapping out the human genome, a person’s genetic code remains as perplexedly complex as ever.

There are too many risks involved in interpreting genetic information. In one case, a woman underwent extreme surgery and had her uterus removed due to an incorrect reading of her ge­netic-test results. Unfortunately, these accidents are not uncommon. There are also problems outside of the scope of the medical field. Once an all-encompassing patient database is established, countless issues involving ethics arise. Say that the ideal scenario of establishing precision medicine comes to fruition. Who would claim ownership for this data? How do we make sure this information isn’t abused and used to deny insurance coverage or jobs? What is to stop insurance companies from raising premium prices once the person’s genetic information is available?

These are all valid points to consider that come with an issue as complicated as this. This leads to concerns about security. Hospitals and other havens of digital, medical information are easy targets for cyber-attacks. Just recently, a string of hospitals in California, Kentucky, and Maryland became victims of information technology breaches and were forced to pay a ransom to convince the hackers to return the databases to normal. If something similar happened to the precision medicine patient database, the consequences could be catastrophic.

The most important message is that we should always carefully consider all the possibilities before launching headfirst into what seems like a great idea. The extreme hype over precision medicine as some great benchmark in health­care will only blind us to the possible pitfalls that might appear. Sure, the likelihood of disaster may be small, but if it does happen, there will sufficient blame-tossing to go around.

Precision medicine makes great promises to dramatically improve the quality of life with one simple end goal. However, one must not get dragged away by the illusions of grandeur. For now, it’s best to approach the issue with caution.

Originally published on April 13, 2016, in The Miscellany NewsRisks of precision medicine need review

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