PRECISION medicine is an approach for disease treatment and prevention that takes into account the individual variability in genes, environment, and lifestyle.
In simple terms, precision medicine involves genetic analysis to help clinicians establish a more accurate diagnosis and also to decide on the most suitable treatment available.
Our DNA is the instruction book of our life. It is amazing how these tiny protein molecules are the fundamental building blocks of human beings.
While all men and women are 99.9% identical genetically, the 0.1% difference is what makes each of us unique, and sometimes the determinant of our health and disease.
Born in the time of evidence-based medicine, I was taught that the effectiveness of a treatment should be proven by clinical trials. What clinicians believe to be the “gold standard” of treatment is usually based on the result of a randomised controlled study.
For example, if a proposed drug is proven by clinical trials to be 85% effective, it is then believed that 85% of the patient population would respond well to it.
The question is, what about the other 15% who did not respond well? Why are they not responding well like the other patients? Should we reconsider other possible diagnoses? What should be the ideal treatment for them?
This is when precision medicine comes into play, leading us to the answers for all these questions.
Precision medicine is already being practised locally, especially in the field of oncology. All cancers are caused by gene changes of some kind. Cancer cells are abnormal versions of normal cells, meaning that something changed in the genes of a normal cell to make it turn into a cancer cell.
For certain cancer types, doctors can now test for gene changes that can tell if a person’s cancer might respond better to one particular drug rather than another.
Familial hypercholesterolemia is caused when a person has a gene that results in high cholesterol level at a much younger age. If the gene is present, the individual will have up to 20 times higher risk of heart disease and at a much younger age as well.
If these individuals are identified early, their family will be prompted to get tested as well.
Early inexpensive interventions like lifestyle modification and adopting a healthy diet, which are more cost effective than the downstream treatments needed for chronic diseases, can then be implemented. These are just a few of the many things precision medicine has to offer.
In 2012, the prime minister of Britain launched the 100,000 Genomes project in England. The United States followed suit with the announcement of its own Precision Medicine Initiative in 2015.
I am glad that our country is on board with our own initiative in the recent year, albeit a little late. But it is never too late to move forward. However, precision medicine comes with a hefty price and challenges.
Embarking on this journey requires a lot of resources and financial support for research.
Genetic testing, for instance, is expensive, so how do we make it affordable for all?
Medico-ethical and insurance coverage eligibility issues may also arise from genetic testing and data collection.
Initiatives and efforts by the government, Health Ministry and research institutes play a pivotal role in making precision medicine possible for Malaysia.
Let us not forget the importance of public awareness and education in making it happen as well.
I believe precision medicine is the way forward, the future of medicine, the new era.
DR JOWYNE YAP