Personalized medicine

It’s time to think of health in a disruptive way. Policy must set the enabling landscape, but the truly dramatic and the transformative will come from the exploding but still very young field of personalized medicine.

All healthcare is local, and all health is personal.

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Personalized medicine is healthcare targeted to YOU, and just you. It means your individual health interventions — prevention, diagnosis and treatment — are custom-tailored specifically for you. Our individual needs — based on our personal DNA, the expression of powerful proteins and each of our unique biological responses — determine how our bodies respond to diet, to medicines, to exercise and to various modes of treatment.

A more individualized and personal approach translates to earlier prevention and diagnosis, and more targeted and appropriate treatment. By eliminating overspending in prescribing drugs that don’t work and under-spending on prevention and wellness, it opens the door to slowing the relentless growth of healthcare costs.

Personalized medicine is coming of age. Genetic testing, when coupled with massive clinical data sets made possible by privacy-protected electronic health records, can show predisposition to a growing list of conditions so that preventive action can be taken to maximize health and well-being and minimize expensive interventions in the future.

For example, if you know your genetic code demonstrates a risk for breast cancer, you can proactively engage in more prevention, be it more frequent self-exam and imaging or adjusting your diet. If you need to take a medicine to keep your blood thin after a stent placed to reverse a heart attack, you can be assured you will take one that not only works but also causes the fewest bad side effects. And this earlier detection of disease and targeted use of drugs leads not only to better life but also real cost savings.

The conditions for which we have genetic and proteomic tests for risk profiles is growing daily. They include heart disease, such as atrial fibrillation; cancers of the stomach, colon, lung and breast; vascular aneurysms and thrombosis; multiple sclerosis and Alzheimer’s disease; Crohn’s disease and type 2 diabetes. For the most part, we don’t know the exact cause of these diseases; it’s a combination of genetic and environmental factors. But the tests can give us predisposition to and risk for disease, and thus allow us to take early action.

One exciting field that will have a measurable clinical and cost-saving impact is pharmacogenomics, which focuses on how people with different genetic variants respond to certain medicines. It is transforming the pharmaceutical industry. For my field of organ transplantation, a genetic test at Vanderbilt shows whether an anti-rejection drug is likely to be effective —this can be a matter of life or death. Your genetic code can show whether a drug will work, or even whether it will have side effects. It can determine the appropriate dose to achieve the best and safest effect for you.

Obesity is destroying our children’s futures. We are today raising a generation of children who will not live as long as their parents. It is currently thought that two-thirds of the risk of obesity is associated with genetic markers on particular genes, while about a third is attributed to pure environmental effects. The genes might not cause obesity, but knowledge of increased risk markers just might give us the motivation to alter our nutrition and exercise habits, and modify our lifestyle and behavior.

Increasingly we will see individual genome sequences become a formal entry in our medical records, just like allergies and history of previous surgeries. As information technology in healthcare matures, we will see more connectivity among providers and labs, more support to eliminate costly and deadly medical errors, more automation to reduce the chances of making bad mistakes, and more data mining that will lead to science-based predictions of how to reverse disease and prevent it in the first place.

Government investments can really pay off — we shouldn’t forget that in the spending debates that are sure to follow in Congress. For instance, the government-funded Human Genome Project, begun in 1990, was completed two years ahead of schedule in 2003, and under budget! That project determined the sequence of nearly all of the more than 3 billion chemical building blocks that comprise the human genetic code.

Personalized medicine is more than DNA. Your individual genome is the original blueprint, or plans, but the final human body actually reflects a complex system of environmental and genetic influences, expressed through more than a million different proteins. Advanced computing and a systems-engineering approach to massive databases will open even more sophisticated and useful personalized medicine fields, and a new healthcare revolution will begin.

Frist is a former heart and lung transplant surgeon and is currently an adjunct professor of surgery at Vanderbilt University. He served as majority leader of the U.S. Senate from 2003 to 2007.