Creating a Healthcare System that Fosters Personalized Medicine

The expression personalized medicine is the most prominent catch phrase in healthcare today, meant to convey a message of cutting edge treatment and patient care. Personalized medicine is based on the idea that individual genetic differences can affect the way a patient responds to certain medications. As a consequence, genetic differences are likely to contribute to the variability in the efficacy of some treatments (i.e. the same drug that works for one patient doesn’t work for the next), as well as side effects that may outweigh the benefits of treatment. Therefore, the efficacy of personalized treatments are attached to some type of biomarker; a genetic or other biological feature that can predict the efficacy of a particular treatment in a particular individual. To date, there are some biomarker-treatment combinations that have been very successful, particularly in the field of oncology (cancer treatment). However, in order for personalized medicine to reach its potential, ongoing scientific research is needed in identifying subgroups of patients. With these subgroups identified, doctors can better understand treatment response to different classes of drugs. This process needs to be continually repeated in order to tailor therapies to individual patients; in the long-term, this process will increase the effectiveness of healthcare systems.

Personalized medicine is in its infancy; while there is great promise in personalized medicine, there are several limitations on current treatment. Some of these limitations include a lack of biological markers, little or no information about individualized treatment outcomes, and rising costs of new therapies. Most importantly, in order for personalized medicine to be successful, healthcare systems need to continually refine education of healthcare providers (especially physicians). There is a strong push to create large data sets that can be used by scientists in identifying new biomarker-treatment combinations; physicians should be part of this process as they have direct access to both patients and scientists. Of course these initiatives are often hampered by a lack of funding, but this could be overcome by making research more efficient in large academic medical centers. Physicians need to be at the center of these research projects as their high level of knowledge about the disease state can inform future research endeavors.

Moving the Field Forward

There are a tremendous number of obstacles to overcome before personalized medicine truly becomes the standard for mainstream treatment of disease. Some of the early hurdles include National Institute of Health (NIH) funding for translational science, as well as proof of concept research to entice drug companies in the private sector to develop novel biomarker-treatment options. Conversely, the success of these biomarker-treatment combinations is directly dependent on research taking place at academic medical centers. Oncology has become a kind of poster child for personalized medicine because cancer is fairly common, it has distinct genetic features, and it gets a lot of attention from both the media and the scientific world. As this offers a type of low hanging fruit, a short-term strategy should include making immediate advances in cancer treatment. 

Educating Physicians

By its very nature, personalized medicine requires constant updating in order to refine treatment protocols. One of the major challenges in implementing personalized medicine is the need to educate physicians. Young physicians need to be exposed to personalized medicine in every facet of their education. In parallel, McDougal and Rosamond (2010) note that more established physicians must stay up to date with the rapid growth of information in their respected fields. In addition, The Advisory Board Company (2015) found that healthcare systems will need to build in educational and research programs to keep physicians on the cutting edge of personalized medicine.

The Business of Healthcare

The culture of personalized medicine must reflect a business model that makes sense to insurance providers. From the provider’s viewpoint, new therapies have to be more efficacious in order to offset the (inevitably) growing cost of offering personalized treatments. In addition, there needs to be clear communication between academic medical centers, pharmaceutical companies, regulatory agencies, and insurance providers. While there is little doubt that personalized medicine will yield vast long-term benefits, clear communication between these entities will ensure that the most promising therapies are being realized immediately. In the short-term, this will entice insurance providers to cover the cost of care for superior treatment options and ultimately have great benefit to patients.

Pharma-centered Approach

Much attention has been given to the role of large pharmaceutical companies in developing personalized treatment options. Indeed, Big Pharma has a major financial stake in the future of personalized medicine. However, relying on pharmaceutical companies to develop therapies is problematic, as many pharmaceutical companies are cutting back on research and development in favor of buying small companies that have a product in phase 2 clinical trials. Because of this, academic medical centers will play a large role in developing new targeted therapies for cancer and other treatments, and should look for collaborative opportunities for funding from pharmaceutical companies.

Disease-Risk

 The long-term goal of personalized medicine should be to shift from disease treatment to disease prevention. Although there has been some success in identifying risk factors (i.e. Alzheimer’s disease and breast cancer), direct-to-consumer companies (that rely on genetics alone) have been unreliable in identifying these risk factors for many patients. A more refined approach will combine genetic information with other biological variables. This type of sophisticated approach requires constant refinement and significant investment in ongoing research. As such, the long-term goal of disease prevention is best realized through research that explores the nature of specific diseases from the perspective of patients, physicians, and scientists.