Why personalised medicine is more personal than you might think

By Tony Mallett, freelance journalist and EU Reporter health correspondent

Welcome to the future. Thanks to phenomenal leaps in science and technology we are already in a world where personalised treatment, largely based on individual genetic profiling and a citizen’s DNA, is being applied successfully in several fields for the benefit of Europe’s patients.

Cancer and rare diseases are the best-known examples, but areas such as nutrition, psychology, cardiology and infectious diseases have also applied the concept, with excellent results.  Personalised medicine (or ‘precision medicine’ as President Obama’s recently launched initiative calls it) is a fast-moving field that sees treatments and drugs tailored to a patient’s genes, as well as his or her environment and lifestyle. It aims to give the right treatment to the right patient at the right time, and can also work in a preventative sense.

But isn’t all medicine ‘personalised’? Well, no. Doctors tend to prescribe by population. If a treatment works for the biggest percentage of patients, most will default to that.

However, it is clear that we are all different and one-size-fits-all approaches no longer work in modern-day healthcare.  For example, there’s no point giving a cancer patient chemotherapy if there is a large chance that it will not work. This is a waste of time and money and, potentially, a human life. It is far better to know in advance what the best treatment will be, to discuss it in a fully transparent way with the patient and then to point him or her in the right direction.  To augment this, the holistic approach aims to ensure that the patient’s lifestyle is taken into account when prescribing treatments and also seeks to ensure that the patient is involved at every stage of the development and treatment of his/her disease or diseases.

This co-decision requires not only knowledge on the part of the patient but also up-to-date training for the healthcare professionals and others involved in the process. A willingness to share this information in an equal relationship with the patient is a cornerstone of personalised medicine.  More than at any other time in history, science offers enormous potential to transform the prevention, diagnosis and treatment of many diseases. Rapid advances in the understanding of human biology and the underlying mechanisms of disease offer many new potential targets for medical product development.  But supporters of personalised medicine (of which there are a growing number), admit that there is still a long way to go to realise the full potential of scientific discoveries and their translation into the therapies needed to confront the pressing health problems of today.  Patients are urgently awaiting new therapies – and too often not getting them. And researchers and companies also face significant development obstacles as only one-in-ten drugs entering clinical trials ever makes it over the finish line.  Cutting-edge science has allowed the breakthrough of personalised medicine but it needs to be integrated into daily healthcare. Education is one pre-requisite for this to occur but there are other hurdles to be overcome…

The development of personalised medicine will necessitate the removal of ‘silo mentalities’ in different disciplines and with individual member state health systems. There is also a need for much more cross-border co-operation and collaboration.

Personalised medicine will also require complex international clinical trials involving highly selected patient populations, the collection of human biological material and the use of large databases for bioinformatics – Big Data. There are, of course, huge collection, storage, sharing and (not least) privacy and ethical issues surrounding all these data.  Of course, cost is a major issue too and often leads to a sharp intake of breath when personalised medicine is mentioned.

Yet its proponents claim that ‘too expensive’ is not the case in the medium- to long-term; they say that better diagnostics will ease the burden on healthcare systems in two ways – firstly it will allow a more preventative approach in that gene technology will flag up the likelihood of a particular individual developing a particular disease and provide a good idea of how it will develop, thereby encouraging early intervention.  Secondly, they argue, efficacious treatment means patients are much less likely to require expensive hospital beds and are more able to continue working and contributing to Europe’s economy.

Denis Horgan, executive director of the Brussels-based European Alliance for Personalised Medicine (EAPM), told EU Reporter: “In a 500 million citizen-strong EU staring into the abyss of a society with an aging population that will inevitably become ill at some stage, giving patients access to the best possible treatment available in Europe is not just a moral issue, it’s a financial one, too.

“Slashing health budgets is a patent nonsense. A healthy Europe is a wealthy Europe and the EU in general, and healthcare systems in particular, need to see what’s staring them in the face.

“Generally speaking,” added Horgan, “in testing times, money spent on health services to citizens is always among the first targets. But this is short-sighted – not only from an individual country’s point of view but across a union with a population that will all become ill at some stage.”

EAPM, which brings together patients, medical professionals, health-care planners, scientists, industry and researchers, argues that cutting back on health care will lead to less quality of life for patients and make them more, not less likely, to need expensive hospital treatment and will see them spending less time in the workplace where they would be actually contributing to the wealth of the EU.  Patients are all for it, of course, but regulators are wary and, in some cases, behind the times. Meanwhile, payers have their own views on what constitutes ‘value’.

The arguments will continue but there is no doubt that personalised medicine is here to stay. So much so that the current rotating presidency of the EU, Luxembourg, held a conference on the subject in July and will highlight personalised medicine in its December Council Conclusions. This is a huge leap.  “You can’t stop science,” says Horgan. “And while integrating personalised medicine into daily health care will be a long, hard road, the journey has well-and-truly begun.”

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