Natalie Jackson
PhD Student, College of Nursing
University of Utah
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.
