As promised – here is the second post of two to begin my hopefully-more-regular posting of blog posts!
As a change of pace from the “Problems in Pharmacology” series of posts, I thought it would be good to provide a solution. Pharmacogenomics is a merging of pharmacology and genetics, wherein genetic information from the patient can be used to determine their response to a drug.
Personalised medicine is a proposed method of healthcare that involves tailoring a patient treatment to that patient. This seems like a no-brainer: surely every form of healthcare should be personalised? However, in order for healthcare to be fully personalised, we must use pharmacogenomics. Conventional medicine treats a patient’s symptoms, and perhaps biomarkers (such as chemicals found in their fluid samples), with therapeutic drugs known to reduce these signs, and therefore likely the disease the patient has.
The current healthcare system is reactive, requiring evident symptoms to treat conditions, and thus blocks innovation and inherently finds it tricky to treat conditions with little to no symptoms. The future of healthcare therefore lies in treating the mechanisms of disease, based on evidence found inside the patient.
In order to obtain this “evidence” professionals need to be have genome-based training, and we must integrate the technology necessary into our healthcare system. Instead of looking for symptoms, we should also look at a patient’s risk factors – factors which would enable the development of risk patterns for understanding the various differing diseases leading to a patient’s condition.
Unfortunately these steps are extremely costly: it’s unlikely we’ll get to these stages in the near future. But changes in thinking could do a lot to enhance our current understanding of medicine.
We can’t get data from everyone – but we should understand that we don’t know everything about a patient, and that their condition is dynamic.
Incidental findings are not anomalous – they are misunderstood.
Hopefully a paradigm shift from the treatment of “common complex diseases” to “multiple rare diseases” would help medical professionals and researchers to fully acknowledge the depth of complexity in even our common diseases.
Cliché though it may be, we can paraphrase Socrates in this issue: The only thing that we know is that we know nothing.
This post is entirely my own opinion, based on my own experiences – feel free to disagree and share your thoughts in the comments!
A note from the author: As my posts sometimes touch on emotive subjects, comments are disabled after 4 days. This is because, at this stage, I feel that ongoing discussions tend to stagnate.
I agree somewhat, but only if you’re talking about ALL aspects of medicine being personalized. Certain applications of pharmacogenetics to personalize treatments are long, long overdue….such as, e.g. P450 genotypes have been known for decades to predispose ultrarapid or ultraslow metabolizers to drug-induced toxicities, particularly when combinations of drugs are prescribed. A simple P450 genotype screen would save lives lost to what have been, and unfortunately still are today, referred to as “idiosyncratic drug interactions” that were ultimately shown later to have been predictable, had the P450 genotype been known. Sure the cost of screening seems high but tell that to the families of folks who died under such circumstances.