Each of us has a unique DNA, creating predispositions, inherited characteristics and susceptibilities. Why then, should we expect a uniform approach to therapies and treatments?
That may have been the case, until now. We are looking at a future where our medical treatments will be tailored to work with our personal makeup. Dr. Mostafa Hassan, Managing Partner of Hassan Healthcare, brought us up to date on this.
Why is personalized medicine receiving so much publicity these days?
In 2003, the landmark Human Genome Project was completed. It took 13 years at a cost of USD 3 billion for a single strand of DNA to be decoded. The era of personalized medicine had finally begun.
In 2013, genetic testing and personalized medicine received a lot of publicity when the actress Angelina Jolie announced that she had a specific genetic mutation in the BRCA1/2 gene which gave her a 70% chance of developing breast cancer. She decided to take the step of carrying out a prophylactic double mastectomy; surgically removing her breasts to prevent the cancer from occurring.
Over the past decade, our understanding of the link between genetic factors and disease has grown at an exponential rate. With new technologies, data, and expertise, we are able to offer more tailored solutions to people’s healthcare needs. Moving away from a “one size fits all” approach to medicine, to a more personalized effective way in dealing with disease.
With a better understanding of personalized medicine and genetic risks, preventative medicine has become more effective, where we are able to prevent disease from ever occurring rather than treat a disease once it has taken hold. This can be done with a better sense of awareness of your risks to disease and a personalized modification to your lifestyle, diet and other mitigating factors.
Do you think it will be the standard approach in the future?
I have no doubt that personalized medicine will be standard practice in the near future. Three questions need to be answered before a new medical technology is applied. Is it more efficacious? Is it safe, and is it more cost effective? I believe that we are very close in approaching safe, effective and economical methods of personalized medicine. For example, as I mentioned previously, the cost of sequencing a whole DNA in 2003 was USD 3 billion, but as of today you can sequence a whole DNA for as little as USD 500! And I believe that very soon we will be able to do it for a fraction of that.
One technology that Hassan Healthcare is developing for the Egyptian market in partnership with Clinprime is that of remote patient monitoring. This is where a patient is able to update his/her doctor from home about vital clinical parameters such as blood pressure or sugar levels which can be uploaded through the phone. The doctor is then able to monitor these parameters over long periods of time and form a more accurate picture of the patient’s health. Research has shown that this form of monitoring can help patients achieve much better health goals.
Personalized medicine will be a standard part of the healthcare process in preventing, diagnosing and managing disease. I believe that it will allow us to offer more effective and equitable healthcare services to people as well as save a lot of the unnecessary costs that go into treatments.
What sets it apart from routine therapies and treatments?
Personalized medicine is a more effective approach to treatment. Consider a person with diabetes. There used to be a standard “trial and error” approach to treating this condition where a person first tries one drug and its efficacy and tolerability is assessed. If it is not effective or the patient is having bad side effects, then another drug is tried and the same process is carried out.
In personalized medicine, we recognize that not everyone responds to a treatment in the same way. We can offer tests from the beginning of treatment to determine which medicines will be most effective.
This can be done through genetic testing where some people have the genetic predispositions to be high or low metabolizers of certain drugs. So knowledge of a person’s tendencies can guide a doctor on which drug to choose in the beginning, thus save time in reaching an effective treatment plan.
What is involved in creating a personalized medical profile?
Personalized medicine takes a more wholesome approach to treatment. Many aspects need to be taken into account such as age, sex, genetic factors, diet, lifestyle, and even socio-economic status. It is an approach that aims to tailor treatment to best serve the needs of a specific patient rather than develop treatment protocols that, on average work, but might not work for everybody.
What tests need to be carried out and what does each one show?
Since each person or case is different, there is no standard approach to investigation although many tests will be commonly used in personalized medicine. These include genetic testing, health/cancer screening, and remote patient monitoring. Each test can give a more detailed idea of a patient’s health profile.
How can a family physician apply the information received when treating a patient?
Family physicians are doctors who know the patients best. Ideally, they have been seeing them for a very long time and have a good idea of their medical history as well as other factors such as whether a patient is married and has kids.
That is why family physicians can be the front line of personalized medicine, where all information gathered can be kept with him/her, and the family physician can make wholesome decisions regarding a patient’s health plans. For example, if a family doctor sees that a person had a genetic test which revealed the patient has a high likelihood of developing prostate cancer, the family doctor should then carry out the necessary screening tests such as prostate exams and PSA tests at the appropriate time.
Another example would be a diabetic who is using remote patient monitoring of his glucose levels and sees that the patient has had months of bad glycemic control, then he/she should be referred to a specialist to offer better treatment.
Which are the most common diseases that benefit from a person having made these tests?
Much media attention has been turned towards cancer, which is an important healthcare concern, but there are many other diseases that cause as much or even more deaths such as heart disease, chronic lung diseases, stroke, and cerebrovascular disease.
I would also add that personalized medicine has an important role in chronic diseases, conditions such as diabetes or emphysema where a patient may suffer for many years and need numerous visits to the doctor or clinic for help. A personalized approach may be effective in easing the suffering by adjusting the healthcare plan to that patient. A family can be counselled about a genetic condition that runs in the family, and can seek help with many aspects such as family planning.
A Final Word
One big concern in genetic testing is data privacy and the safe storage of such personal information. Who “owns” the data? Is it the patient or is it the genetic testing company? Can the genetic testing company share this information with third parties? There is also the question of who this information should be shared with.
Many of these ethical questions are still being debated and discussed in the medical community, and I’m sure with the advancement in medical sciences, many other questions will emerge.
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