News at NCH
"Precision Medicine" by Allen Weiss, MD, MBA, President & CEO


Precision Medicine


June 1st, 2012 - Medicine is changing dramatically! Since the dawn of the age of genetics—which officially started in 2001 with the unraveling of the human genome—recent advances have led to an explosion of new diseases. These illnesses and conditions are better defined by their molecular composition and, therefore, are more easily diagnosed and better treated.

According to a recent article in HealthDay, the age of “targeted therapies” or “personalized medicine” started in the early 1980s with anti-estrogen breast cancer therapies such as tamoxifen. Today’s major progress against cancer began 40 years ago when President Nixon signed the National Cancer Act, declaring “war” on cancer. Understanding the genetic basis for cancer or other diseases will make treatment more precise and effective.

An important weapon in this “war” has been the use of computers to facilitate the faster unraveling of new genetic and molecular targets on lung, colorectal and other malignant tumors. These targets might be susceptible to specific therapies based on their composition. Having easier access to a tumor’s genetic “fingerprint” makes precision therapy more likely to be utilized and effective.

This splitting of various types of cancers previously thought to be either identical or at least similar has resulted in reclassifications based on specific genetic makeup. Thus, two end-stage cancers may look similar to the naked eye or under a microscope but actually be worlds apart in genetic makeup and, consequently, require hugely different treatments.

A new taxonomy or nomenclature which is a way of naming diseases or tumors is being developed by the World Health Organization (WHO). Previously what were thought to be identical or a least similar disease states are now being separated into two different diseases. The understanding that what was formerly considered one disease is actually two different conditions in cause, physical structure, chemical composition, overall prognosis, and specific treatment, is critical for patients and those caring for them.

These different diseases, tumors and treatments will employ precision medicine and require handling of complex data, complicated treatments and a whole different environment of care. Genetic testing is now coming to the forefront as approximately 2,000 clinical conditions are associated with known genetic deviations. Many leading institutions are including genetic analysis routinely for certain diagnoses.

As noted above, the age of digital medicine also acts in combination to improve diagnoses, treatment and ultimately prognosis. Decision support tools, such as information technology’s artificial intelligence, are on the verge of assisting at all phases of clinical interaction—from early diagnosis, to confirming therapy, to estimating prognosis. Computer power is changing the way we practice medicine.

By customizing treatment for a particular patient with a particular tumor or cancer, many unnecessary side effects can potentially be avoided. Traditionally, numerous oncology therapies employed a “shotgun” approach, with multiple medications given at just below toxic doses, with the hope that cure—or at least survival time—will be prolonged. Unfortunately, some of the side effects worsened the quality of life, even though life span might have been minimally prolonged.

With the right targeted medication given at the right dose, the dual goals of prolonged survival with better quality of life are now much more commonly achieved. Of course, this is just a beginning and much more needs to be accomplished so that many other diseases can be specifically targeted. As science improves and genetic analysis becomes more automated with the use of digital technology, healthcare will continue to improve.

Not only will prognosis improve but the cost will be lowered. And, most importantly, needless suffering can be ameliorated. A recent New England Journal of Medicine article concluded that ultimately, precision medicine will ensure that patients get the right treatment, at the right time, with minimum side effects and maximum benefits. The benefit of helping to control costs will help our nation’s economy, as we all have a better chance of surviving a dread disease.


 
Past Health Advice Articles

Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.