Health care spending in the United States in recent years has been, and continues to be, a highly publicized and politicized topic that directly impacts the physical and financial well-being of the nation.
Health care expenses and outcomes vary, depending on treatment methods chosen by physicians, and patients’ responses to those treatments.
Managing treatment choices and predicting health outcomes is at the center of a burgeoning medical model known as “precision medicine” or “personalized medicine.”
In the precision/personalized medicine model, patients are divided into treatment groups based on similarities that go beyond a general diagnosis — for example, all lung cancer patients, or all patients with heart disease.
In 2003, the National Human Genome Research Institute announced that the human genome had been mapped.
Since then, advances in technology have allowed medical professionals to begin further sequencing and analyzing the genetic content of individual human beings. This work is happening in Las Vegas at the Nevada Institute of Personalized Medicine at UNLV.
The NIPM is focusing its research on integrating genomic sequencing into treatment options and will navigate the challenges regarding privacy and use of health informatics.
Precision medicine physicians and researchers can use that genetic data as a basis for studying, and eventually predicting, a particular patient’s likely response to treatment based on their genetic makeup.
In the precision medicine model, health care providers can then group patients with similar genetics together and tailor their treatment to be as effective and cost-efficient as possible, forging new options not only for clinical settings, but also for pharmaceutical research and development.
Currently, many cancer patients are treated by specific protocols that are based in large part on the genetics of their cancer.
For example, in the past, early-stage breast cancer patients had routinely been treated with chemotherapy to prevent recurrence, even though many would not benefit. Now, based on the activity of 25 genes in the cancer, patients can be identified with 98 percent accuracy who will not need chemotherapy after surgery.
Such precision in diagnosis and treatment can save millions (possibly billions) of dollars in health care costs. The successful use of precision medicine will drive best practices and policies for clinical medicine and the way we approach health as a society.
Products currently in development could allow this pioneering model of health care to be customized for patients to the degree that individuals buy cars or purchase a laptop.
Currently, physicians participating in precision medicine are often able to predict if patients are susceptible for developing many diseases. The public discussion of the BRCA1 status of Angelina Jolie demonstrates how this has worked its way into public dialogue and has had an impact on the health decisions of many women.
As we identify more genes that demonstrate risk for developing a disease, especially those in which personal behaviors affect the risk, then having access to a person’s genetic makeup, personal behaviors and medical record data becomes even more important in providing medical guidance — and perhaps insurability.
In theory, the more data researchers have to compare retrospectively and prospectively, the more they can make correlation and causation analysis that will flow down to individual patients.
Because much of individual genetic testing is now contributed to large genomic databases, it is the thought of some researchers that the rights of individuals to keeping their genetic and medical record data private is outweighed by the benefits to humanity of identifying specific disease-causing mutations that can be used for precise diagnosis and to guide treatment.
Precision medicine is most effective when researchers can access huge amounts of data to make these analyses. Some individuals, including patient and data privacy advocacy groups, feel that the risk-benefit ratio swings in favor of individuals’ data rights.
Others who are making the case against precision medicine argue that the risks in mistaken or misdiagnosed genetic tests can result in hugely problematic outcomes, like the removal of an organ due to a mistaken genetic test that stated the organ carried a genetic marker for cancer.
While those risks may be possible, the data can also help create small uniform groups of subjects for clinical trials that can shorten drug development times and reduce clinical trial costs.
With time, the advances in science and medicine will almost certainly lead to a dramatic shift in treatment modalities and therapies.
At a minimum, physicians and hospitals are being forced to change how they operate by choosing the most efficient manner to treat patients, as they will only survive financially if they move with the tide of change.
Regardless of how we get there as a society, one can certainly hope that one day the blueprint of ourselves, our DNA, is the basis for treatments tailored to each and every person, where we are not reacting to diseases, but instead are preventing them.
Emily K. Weber is a shareholder and Kandis N. McClure is a policy advisor, both with the law firm of Brownstein Hyatt Farber Schreck in Las Vegas.
