Proponents of personalised medicine argue that when it comes to managing our own health, most of us are used to the idea of taking a 'one-size-fits-all' approach
Personalised, or 'bespoke' medicine is, in essence, the quintessential amplification of several conventional approaches to understanding and treating disease. What augments its therapeutic pivot are tools that are more well-defined and clear-cut. It offers physicians better insights to selecting a therapy, or treatment protocol, based on the patient's individuality - also, molecular profile. This patient-specific practice has been used, for a long time, in complementary and alternative medicine (CAM), as also integrative practices. It not only restricts harmful side-effects; it also leads to more successful outcomes, including reduced costs of treatment.
Personalised medicine has engineered a paradigm change in our thinking about people and also disease. Of how we are all different, also unique, from one another - of what we eat, what others eat, how we react to, or take stress, or experience health issues when exposed to environmental and other factors. Such variations are now being increasingly accepted in conventional medicine - primarily because they are found in our DNA and also influence our risk of developing a certain disease and/or how well we could respond to a particular line of treatment.
Personalised medicine is primed to tap natural variations found in our genes - because they may play a key role in our risk to developing certain illnesses. This may include external factors, viz., environment, nutrition and exercise. It also corresponds to variations in our DNA, which can lead to differences in how medications are absorbed, metabolised and used by the body. The understanding of such genetic variations and their interactions with environmental factors are elements that could help personalised medicine physicians and clinicians to use better diagnostics and drugs and/or select superior treatments and dosages based on individual needs.
It is established that a majority of genes function precisely as intended. This gives rise to proteins that play a significant role in biological processes, while allowing, or helping the individual to grow, adapt and live in their environment. It is only in certain unusual situations, such as a single mutated, or malfunctioning gene, that our apple-cart is disturbed. This leads to distinct genetic diseases, or syndromes, such as sickle cell anaemia and cystic fibrosis. In like manner, multiple genes acting together can impact the development of a host of common and complex diseases, including our response to medications used to treating them.
New advances will revolutionise personalised medical treatment with the inclusion of drug therapy as well as recommendations for lifestyle changes to manage, or delay the onset of disease and also reduce its impact. Besides, the emergence of new diagnostic and prognostic tools has already raised our ability to predict likely outcomes of drug therapy. This includes the expanded use of biomarkers - biological molecules that are associated with a particular disease state - for more focused and targeted drug development.
Molecular testing is being expansively used today to identify breast and colon cancer patients who are likely to benefit from new treatments and also pre-empt recurrences. A genetic test, likewise, for an inherited heart condition is helping clinicians to determine the best course of treatment.
Such protocols exist for asthma and other disorders, too. This is precisely where molecular analysis of biomarkers can help us to identify sub-types of a disease, while enabling one to monitor their progression, select appropriate medications, measure treatment outcomes and patients' response. Future advances could make biomarkers and other tools more affordable as also feasible for clinicians to screening patients for relevant molecular variations prior to prescribing a particular medication.
It is clear that personalised medicine promises three strategic benefits: 1) in terms of preventative medicine, it will improve the ability to identify individuals who are predisposed to develop a particular condition - this will help to formulate interventions that would prevent, delay its onset and also reduce its impact; 2) a better understanding of genetic variations could help clinicians identify new disease subgroups, or their associated molecular pathways and design drugs to treating them. This could also help select patients for inclusion, or exclusion, in late stage clinical trials; and, 3) predict the best dosage schedule, or combination of drugs, for a particular individual, or patient.
All the same, not everything is hunky-dory for personalised medicine. Critics believe that the whole idea is too much of over-hyped razzle-dazzle. Proponents, however, argue that when it comes to managing our own health, most of us are used to the idea of taking a 'one-size-fits-all' approach - be it medicines, supplements, diets and diagnoses. This may be wrong. What works, as they put it, for one may be a 'flaw' for another. To paraphrase David B Agus, MD, the renowned oncologist, medical technology innovator and author of the ground-breaking book, 'The End of Illness,' "Each patient's individual risk-factors are based on one's DNA, the environment and a preventative lifestyle plan - in response." He explains with statistics-backed guidelines that moving and walking regularly is mandatory, because exercising and sitting lazily is equivalent to smoking cigarettes, while eating and sleeping at consistent hours are imperative, because irregularity triggers inflammation.
The inference is obvious - we should understand our physiology and 'quiz' doctors with the exploratory mind of a gadget buyer. This holds the key to 'making' medicine truly 'personal,' more humane, gentle, effective and safe, while keeping in focus the individual in us - one who is as distinct, or unique, as one's signature, or fingerprint.
Nidamboor is a wellness physician, independent researcher and author
