Today, we live longer, healthier lives than humanity ever has, largely because of modern medicine.
We’ve identified many of the things that make us sick — microscopic bacteria and viruses, chronic conditions caused by lifestyle and genetic makeup. And we’ve figured out how to use drugs and treatments like chemotherapy and surgery to manage and even cure illnesses that would have been a death sentence just decades ago.
Now we have the potential to totally transform and improve the way we care for patients by using something called “precision medicine.”
At the moment, “so much of medicine is just based on the average patient,” according to Dr. Eric Green, who spoke with Business Insider after a talk at Smithsonian Magazine’s “The Future is Here” festival.
“There are so many cases where you’ll give a medicine to somebody and you know there’s a fifty-fifty chance the medication is either not going to work or it’s going to make them sicker and yet you know that 50% it’s going help,” said Green, the director of the National Human Genome Research Institute at the National Institutes of Health.
Diseases and people are both incredibly complex: For example, we might have a drug that barely slows the growth of a common type of lung cancer in the vast majority of the population, but in a tiny percentage of people with rare genetic mutations, the drug could completely eliminate that cancer — simply because those people have the genes that allow them to respond to that medicine. In another case, certain cancers with specific mutations might respond incredibly well to a drug that otherwise has very little effect.
The idea behind precision medicine is that in the future, doctors will be able to prescribe treatments specifically tailored to each patient based on what we know about their genes and other factors that make them unique, rather than rolling the dice with drugs that work most of the time, or — in the cases of some cancer treatments currently under use — only a small fraction of the time. Rather than using the medicine that usually works, for most patients, a doctor could use the medicine that is most likely to work for you.
We can hopefully take what Green describes as a “blunt instrument” and instead have it work as a precise tool.
Finding and understanding the medically-relevant intricacies that are unique to each individual is incredibly complicated. But the Precision Medicine Initiative, announced by President Obama during this year’s State of the Union address, is a massive national project that plans to delve into the specific biology of diseases and the genetic code of individuals so we can figure out what form of treatment works for each person.
Green argued in his “The Future Is Here” talk that, as big as the project is — the president called for $US215 million to start the project in the 2016 fiscal year — we’re ready to embark on this national initiative that could completely transform and refine modern medicine into some thing more precise.
There are five reasons why we’re now at a critical turning point in moving forward with precision medicine, Green explained:
- We understand the human genome better than ever before. Advances in our understanding of the human genetic code have set the stage for this new initiative. In 2003 we finished mapping the human genome, but that just set the stage for what comes next — understanding how to use what we’ve learned about the genome for clinical care. And that’s not the only advance in genomics. Sequencing a genome for the first time took eight years and cost about $US1 billion. In the years since 2003, we’ve developed the ability to sequence a genome for (in some cases) less than $US1,000 in one day.
- Electronic health records mean that more data than ever is accessible to researchers. The transition to electronic health records means it’s now possible to use medical data from potentially millions of patients in research — something that’s necessary to get the large amounts of information needed to understand how specific genetic changes make such a huge difference.
- New devices make it easy for researchers to track the health of study participants. Wearable and smart technology has taken huge leaps forward and can now track data for us and for researchers trying to understand what it means. Green said the National Institutes of Health have worked with Apple and other tech companies so that smartphones will be able to collect data from wearable technology and transmit it back to research institutions, providing more moment-to-moment information about people’s health than has ever been possible before.
- We have the technology that will help us make sense of vast amounts of information. Advances in computer and data science mean that we finally have the ability to process information on scales that were unimaginable in recent history. Each human genome contains about 3 billion data points, and the researchers behind the Precision Medicine Initiative want to start their work with at least one million study participants. Processing all of that information and comparing it to medical history would be impossible without modern data science.
- People want to be involved in this sort of research. Green says that in recent years, Americans have shown a willingness to be a part of the studies that are needed to gather information for the initiative, provided they are considered “partners” who are made aware of what’s being learned from their information and they have the right to withdraw from the work if they choose to. This is more possible now with modern technology than ever before, and that same technology makes it much easier to recruit these partners.
“Ten years from now, you’ll look at [what we’ve been doing] and say, ‘oh that was so crude and rough,’ compared to what we’ll be doing 10 or 20 years from now,” said Green.
What we think of as “modern medicine” now will look like primitive guesswork as we start to understand the factors that make a treatment perfect for one person yet completely ineffective for another.
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