The White House recently released details on the Precision Medicine Initiative, a $215 million research effort that President Obama announced in his State of the Union Address. The initiative aims to generate the scientific evidence needed to move the concept of precision medicine into clinical practice, mostly by funding projects through the National Institute of Health (NIH) and the National Cancer Initiative (NCI). While supporters say the initiative will revolutionize health care, some think it’s just another silver bullet.
Precision medicine is an emerging approach for disease treatment and prevention that accounts for differences in an individual’s genes, lifestyle, and environment. The idea is that most medical treatments have been designed for the “average patient,” and that biotechnology, science, and medical records can combine forces to combat this “one size fits all” approach. Lots of people will be involved, from physicians and geneticists to venture investors and regulators like the FDA.
The most real example of precision medicine is currently in cancer research, where molecular testing has become a routine part of patient care. As the National Cancer Institute writes,
“Understanding the genetic changes that are in cancer cells is leading to more effective treatment strategies that are tailored to the genetic profile of each patient’s cancer.”
The President’s initiative has a short-term goal of intensifying efforts to apply precision medicine to cancer, and the budget allocates $70 million to pinpoint genomic drivers.
Research to further precision medicine is also taking place in diabetes, neurodegenerative disease, cardiovascular disease, and epilepsy. The White House says precision medicine’s potential to improve care and the speed of developing new treatments has “only just begun to be tapped,” and that scaling up initial successes will require a coordinated and sustained effort with collaboration between public and private sectors. The initiative plans to do so by leveraging advances in genomics, new methods for managing and analyzing large data sets, and emerging health information technologies.
While the Precision Medicine Initiative has bipartisan support, there are reasons to be skeptical of all the hype. A recent New York Times op-ed calls it another “moonshot” research initiative, writing that “medical problems and their underlying biology are not linear engineering exercises, and solving them is more than a matter of vision, money and will.”
And while that is precisely what’s being thrown behind precision medicine, the author reminds us that for most widespread diseases (like diabetes, heart disease and many cancers), no clear set of genetic risk variants has emerged for the vast majority of cases. Despite the hype around genomic medicine more than ten years ago – when the Human Genome Project took off and it was thought that genetic variants would be found to account for a lot of disease risk – lifestyle choices and environmental factors still seem to be better determinants of Type 2 Diabetes than particular DNA sequences.
It is also worth considering that precision medicine could have unintended consequences by changing the way people respond to perceptions of risk. The op-ed argues that if people believe they’re at less risk for a given disease, they feel overly protected, resulting in bad behavior that could increase their risk. Similarly, learning that you are at risk could induce fatalistic behavior (if you learn that you have a “risky” DNA variant for obesity, you might decide not to bother changing the way you eat). In a medical system that already over-incentivizes diagnostic tests and procedures, people might also be inclined to get tests “just in case,” leading to more wasteful spending. The pace of progress in precision medicine aside, the op-ed reminds us that health is as much about social factors and individual choice as it is about genetics.
Of course, when it comes to medical progress, a lot has changed since the Human Genome Project was announced in 2001. As IBM points out, while genomic medicine has not turned out to be the panacea that was hoped for, advances have been made and the playing field has changed. Today whole genome sequencing is much cheaper, funding from the public and private sectors is combining this data with electronic health records, and cognitive computing is revolutionizing analysis that supports precision diagnosis (check out our post about IBM’s Watson). These transformations in life sciences and health care industries might make precision medicine different than the hype we saw a decade ago.