"Personalized Health Care - A Gift from Science" By Allen Weiss, MD, MBA, President and CEO

Dr. ALlen Weiss, MD, MBA, FACP, FACR

December 1, 2008 - The personalization of health care is a forthcoming trend that will add value for all patients, caregivers and all those who pay for health care. Personalized health care starts with defining the genes we are born with, which, it turns out, predisposes us to certain diseases. To understand this, let's start with a quick overview followed by an example and some details.

Each human being has a unique genetic profile—except in the case of identical twins who will have the same genes. In 2001, the human genome which is the genetic code found in most of the bodies cells was analyzed for the first time, placing all of us in the age of genetics. Any person can now have a map made of their genes. The process is expensive and matching the disease with its associated gene is still being developed by scientists. We have a way to go but it is definitely on the horizon.

This mapping, in fact, has been done recently on a 50-year-old woman with cancer. Her cancerous cells were compared with her normal cells, as well as with the cells from other people with the same type of cancer and those without cancer. Understanding what predisposes us to a particular disease will help prevent and monitor the disease. If there is a gene commonly found and you have the misfortune of having that gene, it behooves you to increase your surveillance for early systems and signs; in that way you can get timely treatment that typically confers a better outcome. Conversely, if you have a gene which protects you from a disease you can stop worrying about something that is very unlikely to happen.

Knowing ahead of time how someone may react to a treatment is also part of personalized health care. It is already known that many people lack an enzyme in their liver that breaks down or metabolizes medicines. An enzyme is a chemical that digests the medicine. These people need a lower dose of the particular drug and many are told to avoid drinking grapefruit juice with their pills because of the interaction between the juice and medicine when the enzyme is absent.

Until recently, no one even thought about differences in humans taking the same medicines for the same diseases. With personalized health care, a particular patient with a unique disease, as defined by the genetic make up, will get a specific medicine much more likely to be effective and without side effects. Most drugs work only in about a third of the patients being treated. Side effects are too common and can often cause more harm than good.

Instead of treating all people uniformly, we'll be treating patients with their diseases as individuals. Instead of being reactive and waiting for diseases to show up, we will be pro-active and look for the first sign of disease to treat and cure early.

The algorithm of predicting, diagnosing, and treating will replace the current delayed diagnosing based on overt symptoms (things a patient complains about) and signs (physical changes in the human body). Presently, by the time many diseases are diagnosed the disease has already advanced. The “one size fits all” type of treatment currently being used will be replaced by drugs that have been targeted for an individual's gene type and disease.

Sound like science fiction? Personalized health care is not yet widely available but it will be soon. Modern medicine is always evolving and this new development is very exciting for everyone. Think of it as a “gift” from science. Happy Holidays to all.

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.