Maybe you have the big ears that run in your father’s family, and freckles from your mom’s side. Well, if you think your genetic “quirks” made high school difficult, consider the health history in your family tree. Luckily, help is on the way in the form of personalized medicine.
Q: I’ve heard talk of major advancements in personalized medicine, but I’m not sure I understand what it is. Can you define it?
A: While it may seem that the medical care you already receive is personalized (after all, who else is it for?), what you’re referring to is the emerging practice of using your cells and DNA to guide decisions about preventing, diagnosing and treating illness.
When doctors know exactly what’s in your DNA, they can make decisions with much more precision. This can mean everything from choosing medications that will work better for you (and with fewer side effects) to starting certain preventive screening tests earlier.
Let me give you an example of how powerful personalized medicine can be: About 10 years ago doctors abandoned a certain breast cancer drug when they discovered that 80 percent of patients either experienced no benefit or had severe side effects. But as the science has progressed, we’ve learned how to genetically type the women with this form of breast cancer, and it turns out that for 16 percent of them, this drug is extremely effective. So now it’s been brought back for this specific group and is helping to save lives that might have otherwise been lost.
That is the promise of personalized medicine: the most effective drug for just the right people at exactly the right dose and time.
Q: When do you think personalized medicine will reach the healthy patient?
A: It’s already here. Although it’s true that personalized medicine is more commonly used in people who already have an illness, as in the above case, there are many genetic tests available that can determine your risk for certain diseases. For example, close relatives of an Alzheimer’s patient can opt to see if they carry the APO E gene. There’s even a test now that can tell whether you have the DNA “switch” that stimulates brain development when you exercise.
Genetic testing is still pretty expensive (with a price tag that’s often more than $2,000, depending on the test), which is why it’s not generally recommended unless you’ve already got a pretty strong history of a condition. That said, it’s getting cheaper each year, and our guess is that it will be widely used in the next seven to 15 years.
Q: Is this thought to be something that will make healthcare more expensive or cheaper and more efficient?
A: It’s going to be more expensive at first. Just imagine if there are 25 potential variations of prostate cancer (and there probably are) and each requires its own drug to be effectively treated. Not only will pharmaceutical companies have to spend millions to develop and test those new drugs, but then the new drugs will need to be matched against your particular type of the disease, which also costs money. The upside, however, is that we would be able to cure the cancer much more quickly and get you back on your feet sooner.
Without the trial and error to get the treatment right, you avoid unnecessary suffering, and the whole process becomes less expensive for society overall. But it’s going to take some time to get to that point. And you have to do your part, too. No matter what your DNA, making smart lifestyle changes based on your family history alone can decrease medical costs as much as 70 percent!
Q: What is your anticipation of how insurers will react to the coming advancements?
A: With fear—and that fear may be justified. Right now, companies develop drugs intended to be used by vast numbers of people. That mass-market approach can help keep costs down. But if we need more and more drugs for smaller and smaller groups of people, the cost of those medicines will have to be much higher. On the patient side, there’s also the worry that insurers may use genetic information as a means to deny coverage—but fortunately the new federal healthcare law has denied this practice.
Q: Who is on the leading edge of personalized medicine, and do you expect many physicians will seek the training necessary to apply it?
A: Your primary care doctor will be leading the charge simply because she oversees all of your care—starting with making sure you don’t become ill in the first place. And fortunately, the learning curve won’t be steep for any physician.
Thanks to electronic medical records, every doctor you see will have instant access to your complete family history and genetic profile. But again, all of the information in the world won’t help you stay healthy unless you commit to making the changes that will ward off the illnesses for which you are predisposed.
Our biggest challenge remains finding ways to instill the motivation to be physically active, manage stress, eat well and avoid smoking. If you run a company, you have a unique opportunity to help your employees do exactly this by being a role model and using stay-well incentives within the design of your employee insurance programs.
The future of your health (and that of our nation) is incredibly bright if we can just get this step right.