The promise of precision medicine: Care for the whole person

Florence Comite, MD, has an identical twin sister, yet Dr. Comite maintains that they aren't identical.

"Despite the fact that we came from a single egg meeting a sperm, dividing and then separating, I'm an inch taller. We both eat well and work out, but she is thinner; and our tastes in food do not match," she says. "There are differences; how do we account for that?"

Biologically, Dr. Comite and her twin share DNA, but humans are more complex than their biology, and when it comes to medical treatment, each unique individual requires an intervention tailored precisely for him or her – even identical twins. This idea is the premise of precision medicine.

Dr. Comite, a New York City-based endocrinologist who holds a medical degree from Yale University School of Medicine in New Haven, Conn., has been studying precision medicine for the past 20 years, and now runs a successful precision medicine practice.

Precision medicine looks at patients' individual biological and clinical information with the end goal of tailoring interventions to the individual. It sounds a lot like genomics, but Dr. Comite says precision medicine goes beyond genetics. "It's the connection between the way we live life, our genetic makeup, our numbers [in lab tests], as well as our family history," she says. "That, and more, creates the 'precision' in precision medicine."

In other words, precision medicine is the intersection of clinical, biological and population health factors to determine either the best treatment plan for a patient suffering from a disease or, even more so, helping people live their lives in a way to prevent such diseases and ailments from ever occurring. This view redefines the current notion of healthcare, pointing toward the creation of a proactive health maintenance landscape rather than one that is disease-driven.

"The overall goal of precision medicine is extending your health span to match your life span," Dr. Comite says. "Diseases don't develop overnight, whether it is diabetes, heart disease or cancer. Moreover, clues pointing to future disorders of aging, in particular, are detectable and measureable. Genomics adds a brave new world to already-existing and readily available technologies. The key is in translating the data."

This individualized approach to patient care was recently placed in national focus when President Barack Obama announced his intention to launch a Precision Medicine Initiative in his Jan. 20 State of the Union Address.

The White House released details regarding the initiative Jan. 30, including an initial $215 million investment in the 2016 budget. The investments will provide financial support for the National Institutes of Health, U.S. Food and Drug Administration and the ONC to support their efforts in strengthening precision medicine.

The White House outlined five key objectives of the precision medicine initiative: more and better cancer treatments, creating a voluntary national research cohort, a commitment to protecting data and privacy, modernizing the regulatory landscape and developing public-private partnerships.

Dr. Comite says the president's announcement has rallied those in the front lines of this emerging field and applauds his word choice in calling it precision medicine rather than personalized medicine. "I, for one, am happy it's called precision medicine because I feel the term 'personalized' medicine is not enough. As physicians, we, of course, personalize treatment. It goes beyond that now," she says. "I define precision medicine as healthcare that drills down to the cellular level to determine the health trajectory of each unique individual and to permit that individual to own his or her heath destiny in partnership with the physician and other clinicians."

Like all transitions, movement toward precision medicine will not come quickly to the healthcare industry. Approaching medicine from this new angle, one with a proactive and predictive focus instead of a disease focus, asks clinicians to change the way they think about the practice of medicine.

"The whole field of education and medicine is based on the dogma of treating diseases and waiting for symptoms to express themselves," Dr. Comite says. "By the time signs and symptoms erupt, they have existed at the cellular level for years, sometimes decades.  Furthermore, standards of care derived from evidence-based medicine do not take individual differences into account, and that is bound to change."

Dr. Comite says to really succeed in precision medicine, the healthcare industry must embrace a profoundly preventative approach to medicine. This collective industrywide shift in approach will require a change in medical education.

"There has to be a meeting of the minds where medical students are trained in their classes and postgraduate doctors already in the field also learn how to interpret health data before people get sick, before the disease expresses itself," Dr. Comite says, adding that a number of medical centers have already started doing so, particularly in the field of oncology, such as her alma mater Yale University.

However, the entire course of precision medicine doesn't lie in the hands of clinicians and researchers. Patients, Dr. Comite says, will play an integral role in developing precision medicine, especially as wearable health devices and data repositories continue to proliferate and patients take more ownership of their health.

The data collection is already immense, and physicians and researchers must be able to interpret, analyze and translate that information into an actionable plan.

"What has been done with all that information to date?" Dr. Comite asks. "You have it online, in digital form, growing exponentially. Without the knowledge to translate that data, or the wisdom to marry it with genomics, family history and other factors, it is impossible to utilize it."

In the face of precision medicine, physicians will no longer look solely at a tumor's biopsy or prescribe treatments and drugs based on generic, overarching studies.

"We're looking at a total, complex human being," Dr. Comite says. "Each individual must be assessed as a whole person who is more than the sum of his or her parts. Therein lies the promise of precision medicine."

More articles on precision medicine:

Obama seeking hundreds of millions of dollars for Precision Medicine Initiative 
5 things healthcare leaders should know about the State of the Union address 
Phoenix Children's Hospital opens pediatric genomic research & precision medicine institute 

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