Our genes, environment, activity level, and eating habits affect our health in unique ways.
Precision medicine, also known as personalized medicine, or precision & clever science, is a tailored approach to disease treatment and prevention. Although precision medicine is becoming a pertinent field of contemporary medicine, it is deeply rooted within medicine’s historical foundation. It sustains the heart of the Hippocratic oath, which has bound the greater community of physicians across the centuries.
Over time, physicians have undoubtedly tailored specific treatments for patients, based on specific signs and symptoms of diseases. Traditional Chinese and Islamicate medicine, together with European humoral theories, asserted the understanding that a single treatment may not be ideal for every patient who shows characteristic symptoms of a given disease. Premodern physicians tailored their knowledge of etiology and treatments to specific temperatures, blood pressure, diet, and excretions of patients in their care. Contemporary empirical studies of therapeutics also have a long history, including biblical accounts of the effectiveness of Nebuchadnezzar’s diet, and the Persian physician Abu Bakr’s bloodletting tests during the 10th century.
Nevertheless, modern precision medicine is unique from precision medicine of the past, because it is now based on emerging technologies. The biotechnological advances in precision medicine require actions on behalf of a wide range of stakeholders. These include overarching governments, individual patients, and larger medical and medicolegal communities. Contemporary precision medicine uses findings from research in genetics, molecular biology, pharmacology, and medical engineering to determine the most ideal treatment, prevention, or management approach for a disease.
Precision & clever science has not always led to clinical effectiveness. For instance, organizations have offered bogus CYP450 genotype testing services to patients with non-psychotic depression, opposing CDC's evaluation. Genetic tests are not as controversial as the novel concept of using CRISPR to physically engineer human DNA (and create "designer babies"). Yet, there is a strong potential for any establishing medical field to cross the yet unknown borders between ethical healthcare and politics, or healthcare and culture.
In light of this issue, the New England Journal of Medicine (NEJM) published a 2012 article on the preparation needed for the success of precision medicine. According to Cancer Research U.K., time taken to approve studies increased by 65% between 2003 and 2007, while administrative costs increased by 75%. Despite the time increase in approval waiting periods, no substantial bureaucratic measures were taken to improve patient safety. In this regard, the article calls for a balance between ensuring the protection of the patient’s well-being and starting the process before it is too late for the patient.
The article also called out the World Health Organization’s International Classification of Diseases (WHO’s ICD), which did not take into account 21st-century research in the sciences. Seven years after the NEJM article was published, the WHO released a new version of ICD, taking into account new-age diseases, including gaming disorder, multiple-antibiotic-resistant bacteria, the impacts of working conditions in first-world countries vs. third-world countries, and more.
In addition to increasing the accessibility of information and data sources, it is critical to address the challenges of placing new - often technologically complex - demands on medical professionals. Providing the necessary support tools and new educational models would enable experienced health care providers to tackle precision medicine in a comfortable and welcoming manner.
It has been nearly a decade since the Human Genome Project revealed over 20,000 human genes, yet the NEJM article only noted approximately 2000 clinical conditions for which genetic testing was available. Individuals today often use whole-genome sequencing to make more informed health decisions or simply learn more about themselves, yet there is a high probability that complex genomic test results arise. These results may imply an incurable disease, predict non-preventable illnesses, validify suspected diagnoses, or shed light on yet unknown genetic mutations. Still, gene-testing companies struggle to effectively handle the emotional implications related to these kinds of results, especially when they fail to rely on human empathy: medical experts.
Current precision medicine approaches to genomic sequencing are setting new standards for other medical fields. Tools, such as genetic counseling and support groups, are especially helpful to patients and their families in interpreting their results and addressing health decisions. Precise medicine relies on clinicians sharing only the most pertinent information related to patient care. Even medical schools are adapting their medical training standards to emphasize a more compassionate approach to patient care and a more holistic view of illnesses.
Despite the current implications and limits, the goal of precision medicine is to ensure patients will receive the most appropriate treatment for their individual needs. Over the years, precision medicine has prevailed, for it ensures every patient suffers only minimal side effects while maximizing therapeutic efficacy. Meanwhile, it is changing how medicine is practiced and how it is taught. Precision medicine highlights the pertinence of research, thereby changing how research is conducted and regulated. It is even changing how healthcare is being delivered and financed.
For the general public to welcome modern precision medicine to its fullest potential, medical professionals, politicians, bureaucracies, and businesses must come to a mutual agreement. This agreement must assess and act deliberately upon the innumerable challenges that precision medicine continues to face.
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~Ryen Belle Harran~