Personalised medicine: An unstoppable force for good

By European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan

Many stakeholders believe that personalised medicine is the way forward in a European Union with an ageing population of 500 million.

These are all potential patients spread out across 28 member states and this innovative, ground-breaking method of treating individuals - largely based on their specific genetic make-up – is expanding quickly, impossible to halt and promises longer and better lives. 

Properly implemented in health-care systems it will also save money while encouraging investment on a pan-European scale. The pharmaceutical industry is a key partner.  It sets out to produce medicines that do the job for which they were created while at the same time minimizing side effects – often a tricky balance. 

And while a one-size-fits-all model works in many instances – most of us get the desired results from over-the-counter painkillers, for example - there are other scenarios in which it does not and cannot.  Pharma has to react to this, as well as the fact that rare diseases are being discovered regularly and future clinical trials will have to be carried out on much smaller, geographically spread groups.  When it comes to font-line treatment and prescribing drugs, phamacogenetics today can give a clinician additional information about the probability that individuals, with shared genetic characteristics will have a therapeutic response or develop side effects. 

It offers the benefits of more effective and timely treatment. And it leads to better- targeted use of medicines, given that only those patients most likely to benefit will be prescribed the medicine or treatment. 

But personalised medicine is not only about giving the right treatment to the right patient at the right time; it’s also about communication and empowering the patient. This allows the patient to be closely involved in any decisions about his or her health, whether it comes down to the right medicine with respect to their respective lifestyles or awareness regarding the possible, or definite, side-effects. 

Essentially it covers much more than diagnosing and treating patients – however individually and effectively. The modern-day patient wants to be informed in a transparent, unpatronising and clear way about his or her options. 

The Brussels-based European Alliance for Personalised Medicine (EAPM) believes that one of the best ways to achieve this is through investment in better education. This would give clinicians the proper tools to treat and inform their patients and give professionals a better understanding of their patients’ needs. 

But it is also about collaboration and the uses of so-called Big Data – in the lab and beyond. In the past ten years, cutting-edge gene sequencing alongside information and communications technology has changed the way biologists and geneticists go about their science. The data produced requires sophisticated computational skills to be analyzed. And, while bioinformatics is now a well-developed discipline, a new set of skills is required to navigate the masses of data generated. 

It is clear that more collaboration between the ICT and life science industries is required to create solutions that biologists and scientists can use. It is vital, also, that front-line clinicians give feedback to researchers and others working in the pharmaceutical sector and this needs to be at a much greater level than is currently the case. 

In this Big Data era, it is a fact that personalised medicine will deliver its benefits through greater involvement of patients in treatment decision-making and health management.  Clearly, healthcare professionals and those in all other sectors – including manufacturers - cannot be expected to adapt to new ways of approaching patients and coping with new technologies without working together. Meanwhile, for the patients, it’s all about access. Access to treatment and medicines, access to clinical trials, access to more (and clearer) information, access to decision-makers and legislators for the chance to get their voices heard and their needs understood. 

The modern-day patient wants to be involved in co-decision, to own – and have unreserved access to – their own medical data. And they are more than capable of being able to ask questions, even challenge and be actively involved in decisions about their condition, taking into account their own circumstances and lifestyle.  Meanwhile, doctors are expected to make decisions based on the best available evidence regarding the relative costs and benefits of the various treatments – assuming they actually know about them and understand them. 

But it is vital that they take the patient’s views into account. In a world in which patients’ decision making is increasingly being influenced by information available online it remains the case that a doctor is a trusted source of knowledge and advice, and the latter must take into account the person who knows more about his or her own lifestyle than anyone else – the patient.  Communication between all stakeholders in the arena of health helps to empower our doctors and nurses who will then have a greater ability to empower their patients, in order to help them to make more effective choices. 

For example, a clear understanding of patients’ sensitivity to benefit versus risk information and building a meaningful interaction from it is hugely important.  In the main, conventional medicines need to rely on a patient being appropriately informed if they are to be used safely and effectively. Patients need to know how to take their medicines, when and how often, as well as being able to recognise any side effects. This is also the case when it comes to personalised medicines, but the need to understand the special nature of them gives it an added importance. 

Patients need to fully comprehend the likelihood of benefit or harm, while effective and understandable information about medicines is a pre-requisite in what should be a partnership in medicine taking – which sees the patient and professional coming to an agreement about their medicines.  Verbal information tends to be patients’ prefered method but written information is without question an important back-up. Ideally, the two methods should be complementary and act in tandem. 

Adherence, of course, has always been and remains a problem. But it is a two-way problem and not just the fault of the patient. Yes, these days there are wearables and ‘smart’ pill-boxes to remind the patient in the home about sticking to his or her medicines regime but this is often not enough – patients also need to be supported through effective knowledge transfer.  Things are changing fast. The cost of full genetic sequencing has plummeted in recent times and is now less than 1,000 euro. The option of using genetics to stratify medicines is becoming better known by the day. The cat is out of the bag and will not be put back in. 

Therefore, it is incumbent upon all stakeholders – whether they be clinicians, researchers, academics, regulators, patients themselves, payers and, of course, industry - to realise that much more cross-disciplinary dialogue and collaboration is vital. 

This will result in a better understanding of each other’s discipline and allow more effective, modern-day synergies to be developed – for the benefit of Europe’s patients not only in this generation, but for many more to come.  It is a fact that the pharmaceutical industry has a key role to play in the quest for a healthier Europe.

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