Thursday, August 25, 2016

Personalized Healthcare, Personalized Medicine, Precision Medicine- what are they, do they mean the same thing, and why is it important?

Natalie Jackson
PhD Student, College of Nursing
University of Utah
Image:  www.123rf.com

I conducted an unscientific poll by simply asking people what these terms meant to them.  The most common answer (again, remember, unscientific poll) was, “healthcare that’s about you personally.”   When pressed for greater specificity as to whether the three terms all mean the same thing, the majority of people said "yes".  Very few people could provide a precise definition for any of the three terms, and most head never heard on any of the terms.  Does a precise definition exist, and does the average person need to know what these terms mean?  A google search for each of these terms was conducted. 

Personalized Healthcare:
Very conveniently, the Cleveland Clinic asked my very question, “What is Personalized Healthcare?  From patients to medications, one size does not fit all,” https://health.clevelandclinic.org/2012/05/what-is-personalized-healthcare/.  The article notes that many definitions exist, and that (as in my unscientific survey) people will use personalized healthcare and personalized medicine interchangeably.  They note that personalized medicine includes genetics and genomics; more broadly, personalized healthcare includes both of these items but adds in, “any other biologic information that helps predict risk for disease or how a patient will respond to treatments.”

Even though my poll was unscientific, I know we can’t choose only one website and think we have an answer.  Further down on the first page of my google search I find, “Program in Personalized Health Care - University of Utah Sciences” http://healthsciences.utah.edu/phc/.  Luckily, this website has a tab that asks the same question that the Cleveland Clinic does, “What is Personalized Healthcare?” The answer is, “Personalized Health Care is the tailoring of health care to the individual characteristics of the patient. These characteristics can include environment, social history, health history, family history, genetics, proteomics, and more.”  Note the word “can”.  This definition seems to imply that genetics and genomics don’t necessarily need to be part of personalized healthcare. 
Already, we can see that different definitions of personalized healthcare exist.

Personalized Medicine:
We already know from the Cleveland Clinic’s website that they believe personalized medicine includes genetics and genomics.  Again, let’s see if there are other definitions.

A google search of the term “personalized medicine” leads to the following governmental website: http://www.fda.gov/downloads/ScienceResearch/SpecialTopics/PersonalizedMedicine/UCM372421.pdf. This pdf titled, “Paving the Way for Personalized Medicine, FDAs Role in a New Era of Medical Product Development” includes the following definition of personalized medicine from the Commissioner of the FDA, Margaret A. Hamburg, “the tailoring of medical treatment to the individual characteristics, needs and preferences of each patient..."  The article emphasizes that this paradigm introduces emerging science and technology that will focus on therapeutics targeted to the individual while also considering the interplay of genes, anatomical and physiological differences, environment, social, and cultural and how all of these elements might affect how each individual responds to disease. The FDA description appears to include the whole person and even elements outside of the individual that might affect a person’s response to disease. However, the shift toward personalized medicine is not without potential downsides.  An article from CNBC,  http://www.cnbc.com/2015/12/04/personalized-medicine-better-results-but-at-what-cost.html, discusses the expense associated with this paradigm, and notes that it will take time to determine if the expense pays off.

Precision Medicine:
Again, as with the previous two terms, I conducted a google search of “precision medicine”.  The National Institutes of Health notes that, "Precision medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person,” https://www.nih.gov/precision-medicine-initiative-cohort-program.  President Obama has launched a Precision Medicine Initiative with $215 million in funding for 2016 that includes formation of over a million participants to be part of a precision medicine research cohort.  See the infographic below for more details.


Again, as with personalized medicine, questions exist as to whether the money is worth investing in precision medicine. The website for the journal “Scientific American” has a June 1, 2016 article titled, “The Paradox of Precision Medicine” http://www.scientificamerican.com/article/the-paradox-of-precision-medicine by Jeneen Interlandi.  The article notes that debate continues over whether precision medicine will indeed transform healthcare, and, as with the article from CNBC, cost is a concern.

What did my unscientific search for the definitions of the three terms reveal?
Hard and true definitions for any of these three terms seem to be elusive.  What can be said is that these terms all appear to reference a changing paradigm in health care that focuses more on individual characteristics than the previous one “one size fits all” paradigm.  These characteristics might include genetics, environment, family history, social history, culture… all factors that influence your individual health.  A predominant concern regarding this paradigm appears to be cost.

FINALLY….IS THIS TYPE OF HEALTHCARE OR MEDICINE IMPORTANT TO ME AND WHY IS THIS NEW?
This paradigm shift assumes that accounting for factors such as genetics, environment, and lifestyle, to name a few, will provide improved health outcomes for individuals.  The previous paradigm and its assumption of “one size fits all” has not shown great results, despite spending nearly 18% of GDP on healthcare health metrics do not show stunning success.  According to a Commonwealth Fund article, The United States spends more money on healthcare than 12 other countries, but shows worse outcomes in life expectancy and for a number of chronic conditions, http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective

In monetary terms alone, these terms and this type of healthcare and medicine should be important to everyone because 18% of GDP represents a large amount of money being spent on current healthcare strategies that produces dubious healthcare.  Regardless of what it is called, the move to personalized healthcare, personalized medicine, or precision medicine will affect people on the individual and societal level.

Healthcare costs, resources, access, priorities of care, and ethics are beautifully covered in the following article. 

Just Caring:  Assessing the ethical and economic costs of personalized medicine, Leonard M. Fleck, Ph.D, UrologicOncology: Seminars and Original Investigations 32(2014)202–206  Center for Ethics and Humanities in the Life Sciences, College of Human Medicine, Michigan State University, East Lansing, MI,

Key Points from the article:
What is a just and caring society when our resources are limited and our healthcare needs are unlimited?  What are people willing to pay?
Constantly new and improving medical technology and interventions create new health care needs and increases costs
Need to prioritize- we cannot meet all the needs of every person
Social justice- how do we decide?  What are the norms to make these decisions?

An example from the article, and something to think about:
       Personalized cancer research
       Targeted cancer therapy costs: $70,000- $130,000/treatment
       Most only increase life expectancy by weeks or months
       Is this cost-effective?
       Is this a fair allocation of limited social resources
       QALYS- quality-adjusted life years
       Nearly 600,000 people in US die each year from cancer- if each person used only one of these drugs, it would add $60 billion to our health care bill
       Should this money be used on other healthcare needs that will yield higher quality life years at lower cost?
       As a society we need to find a way to decide what we will spend our limited resources on
Additional Links:
The following links provide information on the University of Utah’s involvement in the paradigm shift toward personalized healthcare, personalized medicine, and precision medicine:

Just Caring:  Assessing the ethical and economic costs of personalized medicine, Leonard M. Fleck, Ph.D, UrologicOncology: Seminars and Original Investigations 32(2014)202–206  Center for Ethics and Humanities in the Life Sciences, College of Human Medicine, Michigan State University, East Lansing, MI. 

No comments:

Post a Comment