May 8

May 8 Individualized Medicine: Introduction

Special Report • 2017

It is not often that we see a large shift in the medical community that alters the entire process of how we interact with our doctors and other medical personnel. However, within the next decade we could start to see some groundbreaking changes to our healthcare system as a result of advancements in individualized medicine.

You may have experienced traces of this movement if you’ve had surgery recently and the anesthesiologist analyzed your genome in order to see what drugs would best benefit you during your surgery.

Other physicians and sources have referred to this movement as precision medicine, individualized medicine, or personalized medicine. These terms are used interchangeably in the medical community, but they’re all generally referring to the same topic. For the sake of this article, we’ll stick with individualized medicine.

So what is individualized medicine? Individualized medicine is the process of analyzing a person’s genome to better target their care and identify risk factors that, if identified early enough, could help improve the lives of everyone. In doing so, doctors could be made aware of genetically-linked diseases before they occur — equipping individuals and their healthcare team with the information needed to take preventative measures or tailor treatments to best fit the individual.

So how does it work?

Well, your genome is in every cell in your body, so finding genetic material to work with isn’t the hard part. The only hard part is getting it out of the cell in order to be analyzed. Oftentimes, doctors will take a blood sample or a spit sample and bring that to the lab for testing. There your genome is extracted and run through a computer, and after a short while there’s an electronic map of you saved on the computer. What doctors can do with this information is look at your genome and see how likely you are to develop diseases, metabolize different drugs, process different foods, etc. This benefits both the doctor and the patient because the doctor can with a higher degree of certainty provide care for their patients, and the patients are better able to learn about the lifestyle and medical choices they can make that would best benefit their health, both in the short term and over the long term.

Are there any concerns?

While individualized medicine has the potential to be very beneficial to patients, there are some concerns raised by the ethical and genetic professionals we spoke with. One concern is personal privacy. By someone choosing to release their genetic data, they are also releasing their family’s information. Navigating this dilemma is going to be difficult ethically, especially when trying to create legislation that covers people in these situations.

Other concerns are related to genome sequence integrity. Are doctors only going to accept certain genomes from certain companies in the same way that a doctor can choose to take certain insurance companies? On the other end of that spectrum, how are genome sequences going to be regulated so that someone can’t come in with a poorly sequenced genome that was cheaper and give it to their doctor. As well in that regard, how often are people going to have to update their genome as we learn about better sequencing techniques and learn more about the genome?

The best way to learn about these instances is from the early adopters for individualized medicine. These early patients are going to be how we frame individualized medicine for years to come.

How could this affect me?

In terms of how this might affect you or your family in the near future, this new innovation might come sooner than you think. As a result, your interaction with your primary care physician might change within the near future. Instead of diagnosing illnesses solely from patient provided information and the doctor’s observation, doctors will have a very useful tool to be able to provide care much more effectively and much more quickly than ever before.

However, individualized medicine also has the potential to bleed out into other aspects of your daily life, including your diet. By reading your genome, dietitians can give better suggestions for what foods you should be eating, or how often you should be exercising. They can tell how well your body is able to break down fats and other genetically-linked factors that contribute to your overall lifestyle.

How is Mayo Clinic involved?

Steps are being made by the Mayo Clinic in order to usher in this new age of medicine. For instance, Mayo Clinic was recently awarded a $142 million federal grant to create the Biobank, a biorepository that is designed to hold tissue, DNA, and other bio samples for use in research. These organic materials are going to greatly contribute to future research in the field of individualized medicine, as well as elsewhere in scientific research.

“A lot of this money is coming because Mayo Clinic feels that this is where one of the futures of medicine is going to be, and they want to support that so that we become a leader in [individualized medicine] and we are able to bring that to our patients as soon as possible," said Dr. Timothy Curry, director of the education program for the Mayo Clinic Center for Individualized Medicine.

Already the Center for Individualized Medicine says that they’re in great need for an influx of new professionals who are willing to work on this new revolution of medicine. To prepare for this, the University of Minnesota Rochester is preparing students by having them take genomics-focused courses. In these courses, students are getting first hand look at how individualized medicine might look and how it might affect them as future health care providers.

Timeline

1990: Congress establishes the Human Genome Project
1995: The first genome is sequenced in a living organism, the Haemophilus Influenzae bacteria
2003: The first human genome is sequenced
2005: Medical provides begin to increase use of genomics in anesthesia case
2006: 23andMe founded offering in-home genetic testing results
2008: Time names 23andMe named invention of the year
2008: Congress passes Genetic Information and Nondiscrimination Act (GINA)
2012: Mayo Clinic expands Center for Individualized Medicine to all three sites
2013: FDA orders 23andMe to discontinue certain genetic testing practices
2015: White house announces Precision Medicine Initiative
2017: FDA grants approval to 23andme to reinstate certain genetic tests related to ancestry