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November 8, 2016

Personalised medicine offers chances, faces challenges

Pharmacotherapy based on individual patient characteristics, such as genetic makeup, offers opportunities towards more effective treatment of disease, but also faces a lot of challenges. That concludes the Dutch research institute RIVM in a study concerning possibilities for application of personalised medicine. The study looks at both opportunities and challenges policy wise.

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Genetic characteristics are notably only part (but a big part) of the puzzle to treat a disease effectively with medicines. Other factors play their part, such as age, genus, eating habit, other concomitant disease and the use of various medicines simultaneously. This is the outcome of the Dutch RIVM (Rijks Instituut voor Volksgezondheid en Milieu) research into the opportunities and challenges of personalised medicine, commissioned by the Dutch Health Ministry.

PM new development

Personalised medicine (PM), treatment based on the patient’s unique characteristics, is relatively new in medical society. PM is strongly developing because the influence of individual characteristics on the development of disease and the efficacy of medicines is becoming more evident. Some people have, due to their genetic makeup, a higher risk of severe side effects when using specific medicines. Others are more sensitive to the efficacy of medicines and need a different dose than generally recommended.

Also, the genetic characteristics of tumours in cancer may differ per patient, which offers opportunities for clinicians to tune the therapy based on tumour characteristics and for the pharmaceutical industry to develop customized medication. An example could be medication modules that can be combined in different ways as best suited to treat a particular patient.

Challenges: fragmentation

One of the challenges is to optimally utilize all available data and patients’ characteristics for research. The same is true for the translation of research results into clinical practice. Fragmentation of available patient data or information on treatments for diseases is still a big problem in the Netherlands as it is in most countries. An underlying integrated ICT infrastructure to support for example a single EHR is not yet in place.

Also, the education of doctors and pharmacists must prepare for all developments in PM. In addition, consideration must be given to privacy and ownership of patient data as well as to the suitability of the health care system in the Netherlands to fruitfully implement PM.

Personalsesd genomics

Genetics play a major part in personalised medicine. Personalised genomics seems to be within reach these days, believes Dr. Bertalan Mesko, a.k.a. the Medical Futurist. The cost of DNA sequencing is dropping constantly. When it’s finally available to the majority the whole concept of prescribing medication will change. Pharma needs to get ready for the transformation so it can offer solutions to all. Genomics and truly personalized medicine enable us to receive therapy individually customized to our own genetic background, instead of the blockbusters that are manufactured for millions of people even though we are all genetically and metabolically different.

According to Daniel Kraft, faculty chair for Medicine and Neuroscience at Singularity University and a member of the ICT&health editorial Board, it is becoming exponentially more common to send in a sample from home and obtain personal genomic information. 23andMe began the movement to consumer-empowered genomics and are now leveraging their data from 23andWe data donors to enable faster, novel discoveries. The company published a 450,000-customer study last month,  uncovering a major trove of genetic clues to the causes of depression. And newer players like Veritas Genetics now offer $999 whole-genome sequencing and targeted genetic cancer risk testing.

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