Individualized Medicine: The Future of Health Care
Finding the right medication at the right dose for patients is a large-scale challenge in our healthcare system. Did you know that on average only 40 percent of Americans actually respond to their antidepressant medication they are prescribed? According to Mayo Clinic, 99 percent of all patients have a genetic variant that impacts how medication is metabolized in their body. Medication metabolism is just one of many ways that genetic information can be used to further individualize patient’s health care.
Individualized medicine, although incredibly complex, could increase patient health by increasing efficacy and avoiding adverse side effects. Ultimately, finding “the right drug, and right dose” for each patient.
Right now, different education efforts at institutions, such as the University of Minnesota Rochester, are already being made to increase student’s awareness of the topic and prepare them for cases that they may be working to solve in the future. Additionally, individualized medicine is already being integrated into patient care in organizations like Mayo Clinic.
Individualized medicine has the potential to create unprecedented change in our healthcare system. One of the main objectives surrounding individualized medicine is prevention. According to Dr. Timothy Curry, the director of Mayo Clinic’s Center for Individualized Medicine Education Program, “what we really hope to do is to prevent disease, or to diagnose at a point where it can be treated without having it end up being a chronic problem.”
By using genetic information, medical providers also hope to achieve better patient outcomes. A focus on treatment efficacy through the use of genetic information is already happening in some major institutions, such as Mayo Clinic, however, as we continue to learn more about genetic variants as well as treatment technologies, we may be able to develop a better understanding as to which treatment approach is best for each individual due to their unique genome profile. Learning about genetic variants can help physicians adjust medication and dosage for patients. According to Dr. Liewei Wang, a renowned expert on pharmacogenomics at Mayo Clinic, “we think that this information will help the patients in terms of how to select the best medication or the best dosage.”
As we learn more, we may realize that for some diseases pharmacogenomics works really well, but for instances that are more complex with a rare variant, a different approach might have to be used, such as gene therapy. Individualized medicine provides the foundation to vary treatment to the uniqueness of each individual.
A work in progress
Educating current and future health care providers on individualized medicine is a key step in moving towards a healthcare system based on genetic information. Currently, institutions, such as the University of Minnesota Rochester (UMR), are already working to integrate the topic of individualized medicine and pharmacogenomics into the undergraduate health science curriculum. Students at UMR are directly being exposed to individualized medicine and advanced genetics through data literacy, the use of genomic databases, like NCBI, exploring current approaches, as well as ethical aspects. The university has also had the opportunity to host different guest speakers from the Mayo Clinic Center for Individualized Medicine.
According to Dr. Kelsey Metzger, a professor of integrated biology and genetics at the University of Minnesota Rochester, "having people bring those cases and those real authentic situations into our classroom and saying look this is what it looks like out there, that is really valuable to our students.” Additionally, Dr. Metzger sees these experiences as critical in order to help students better understand the challenges and major questions that current practitioners are already facing; “people who are students now are going to be answering those questions in the future."
But just how much and when will individualized medicine impact our health in the future? The answer to that question is still unknown. However, what we do know, is that it will likely take decades before genomic information with be a main component in our health infrastructure and be incorporated in the medical record for all individuals. According to Dr. Metzger, in the next coming decade or two, the average individual's life will likely not change due to individualized medicine. Rather, individuals with rare genetic disorders, or those diagnosed with cancer seeking genetic healthcare, will be the ones to experience the benefits.
The cost of genome sequencing is also a major barrier for the advancement of individualized medicine. Although genomic sequencing costs having decreased in the past decade, according to the National Institute of Health, the cost of sequencing a genome is approximately $1,000. Insurance coverage also remains a stormy debate. According to Mayo Clinic, “predictive testing is typically not covered by medical insurance at this time so patients pay out-of-pocket for this testing." Once the sequencing price goes down however, the use of genetic information to personalize healthcare will likely increase. According to Dr. Wang, “once the sequencing price goes down to cheap enough, everyone will have their genome sequenced for a variety of medical purposes.”
Overall, the overarching goal is for all individuals to have their genome sequenced and for genetic information to become implemented into electronic medical records. However, it will take time since there is still so much to learn. Although the timeline for using genetic information to individualize health care for each individual seems large, individualized medicine has already impacted current patients’ lives, giving healthcare professionals, such as Dr. Curry and Dr. Wang, hope for the future.
As Dr. Curry told us:
I think we all would hope that you could learn something about yourself that would help you be healthier, not just in your health care, so that you could avoid health care along the way. We also hope that if, unfortunately, you do need health care, or fortunately, depending on how you look at it, that it helps facilitate that, so we can make less errors so that we give you the right drug the first time; we give it at the right dose and make sure that it is the right medication and if you or one of your loved ones gets cancer, hopefully someday we'll be able to treat it better because we will know more about it. It is very complex, so I don't think anyone really knows exactly where it is going in the future and I think that is one of the fun parts about it.
Genomic information is not only for treating patients with an already established disease, it can also be used to improve wellness for already healthy individuals. By using our genetic profile, we may be able to make better decisions regarding diet, exercise, and habits in order to increase or own personal overall health. According to Dr. Metzger, “the value add for healthy people to have genetic testing isn’t really there but it is kind of a provocative area. it is something that is lurking in the background.”
There are a variety of different direct-to-consumer companies that can provide both health and ancestry information to customers. 23andMe, for example, is the first and the only genetic service company directly available to consumers whose reports meet FDA standards. The company is a privately-owned genomics and biotechnology company that provides health and ancestry information to customers. 23andMe currently has more than 1 million genotyped customers and gathers genetic information using saliva tests. The company then provider’s customers with an online report of their lab findings within weeks.
What is some of the information 23andMe’s genotyping can provide you? 23andMe can tell you details such as if you are a carrier for genetic diseases, like Cystic Fibrosis, what your muscle composition and genetic weight are, and your genetic health risk for diseases such as Parkinson’s disease and Alzheimer’s disease. There is no genetic counseling involved and therefore it is just left up to the consumer to interpret and use the information as they please. Interested? Find out more how it works here.
Physicians, however, tend to not use direct-to-consumer data, and would prefer to order their own genetic tests to make sure the lab is compliant with their patient’s specifications. Direct-to-consumer approach is more just for fun. According to Dr. Metzger, “if you really want to know about your health and your predisposition it’s not the route to go.”
However, these companies have allowed individuals to develop a better understanding on the power of genetics.
“I think these [direct-to-consumer companies] have really opened up the eyes to the public in terms of what genetics can tell you, what it can’t tell you," said Caer Vitek, an education operations manager for the Mayo Clinic Center for Individualized Medicine. "I think we still have a long way to go, though."
Cassie Weis is a student at the University of Minnesota Rochester. After graduating, she plans to pursue a career as a naturopathic doctor.
Cover photo courtesy Mayo Clinic