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Precision Medicine and Health Policy

  • Nikhil Chaudhry
  • Mar 21, 2022
  • 3 min read

Precision medicine has the potential to revolutionize the way we think about public health and the implications of policies attempting to mitigate a variety of health issues. Precision medicine emphasizes individual differences in genetic and environmental risk to treat disease, incorporating new technological developments such as Big Data and other information systems. By definition, public health and health policy focus on population-level risk factors and determinants for poor health outcomes. Thus, it seems that these ideas are contradictory, but they intersect in many ways and open the future for better health policy and treatments for disease (1).

With the advent of data collected by individuals conducting precision medicine, public health and precision medicine converge into “precision public health,” where large datasets coming from populations are analyzed to develop effective policy and treatment strategies (2). This level of analysis is unheard of, but extremely valuable in the creation of health policy. Data analysis helps policymakers determine where and how to address social determinants of health within the population. While using Big Data will inevitably come with challenges, incorporating these measures into policy has the potential to inform many new initiatives focused on various subpopulations experiencing poor health outcomes.

Precision medicine within public health was a large focus during the COVID-19 pandemic, where certain zip codes or minority communities were experiencing disproportionately high infection rates with low access to COVID tests or vaccines. Epidemiologists encourage policymakers and leaders to “think local” in order to successfully target the individuals that need the most resources from the government to combat COVID-19 in their communities (3). Given what we know about precision medicine currently, there are many applications of the field to improve health policies related to COVID-19. For instance, testing and vaccine clinics can be established in zip codes with the greatest infection rates and research funding could be devoted to the comorbidity populations with the greatest risk of complications from COVID-19 infection.

Long-term health policies can also use precision medicine. For instance, cancer research has exemplified the crossover between individualized medical care and treating an entire population. Cancer has many individual causes, requiring the use of precision medicine, and its burden of disease is growing exponentially. By focusing on more precise causes of cancer in an individual, nation-wide cancer screening programs can be instituted to potentially detect the same type of cancer in other individuals and begin treatment as soon as possible For example, cervical cancer screening programs are being conducted in Australia caused by HPV, categorizing participants into different groups based on specific genes related to cancer (4). Essentially, this approach involves using individualized data to benefit an entire population’s health. This strategy can be applied to a variety of other diverse health issues plaguing a population, such as obesity or birth defects.

With these positive outcomes in mind, there are many potential challenges that may come with transitioning the fields of health policy and healthcare as a whole to a more individualized focus. Many countries may not have the infrastructure or resources to work with individual data and cater approaches to each patient. Many nations struggle with an extremely low number of medical professionals per capita, which can inhibit these policy implications from improving health (5). In the future, the fields of global and public health must work to address these large issues, as the under-resourced countries would benefit significantly from precision medicine. However, precision medicine has the potential to revolutionize public health and health policy in the future. It is important for policymakers and governmental leaders to consider precision medicine when writing policy to ensure that we continue to advocate for and treat the populations that need it most.


Edited by: Sara Be

Graphic Designed by: Heiley Tai


References:

 
 
 

Precision Medicine and Neurodegenerative Disease

  • Kidest Wolde
  • Mar 13, 2022
  • 3 min read

An emergent issue for healthcare systems is the rapidly increasing number of neurodegenerative diseases along with the exponentially increasing aging population. Advancements in biomedical research and informatics have been extremely important for understanding how genes, epigenetic influences, aging, diet, drugs, and the environment affect health and disease. One such development that may provide a crucial understanding of the brain and neurodegenerative diseases is precision medicine. Precision medicine is a form of medicine that uses information about a person’s genes or proteins to prevent, diagnose, and treat disease. Precision medicine, thus, supports a customized healthcare system, tailored to each patient instead of a one-solution-treats-all approach.


One result of the growing aging population is the increased number of neurodegenerative disorders, and, thus, a higher mortality rate. As a result, hospitalizations, care assistance, and costs for treatment become a larger problem for patients and doctors. The average duration of these neurodegenerative disorders ranges from 2-10 years, during which special care and therapies are required for patients. This creates an overwhelming burden for the patient and the patient’s family. The overall cost for treating patients suffering from neurodegenerative diseases is approximately $130 billion each year [3]. This becomes an even more pertinent concern as the population of the aging population increases. To date, about 16% of people are at least 65 years old in Europe, and this statistic is projected to increase to 25% (9% increase) by 2030, suggesting an increase in cases of neurodegenerative disorders. These disorders include a large number of age-related conditions characterized by loss or dysfunction of neurons in specific areas of the brain and/or spinal cord. Such conditions tend to result in cognitive impairments, a decline in speech, and mobility issues. Among these conditions, dementias (including Parkinson’s Disease and Alzheimer’s Disease) are most common, affecting approximately 7 million people in Europe. Even more alarming, this statistic is projected to double by 2040 [3].

In an effort to improve the treatment and prevention of neurodegenerative disorders, precision medicine may serve as a new—and even better—method of treatment. Neurodegenerative pathologies do not always reveal similarities from one patient to another—even in patients with the same disease. Thus, it may not be beneficial to treat patients with one drug that treats all symptoms of a particular condition, especially if those symptoms are not affecting the individual [1]. In this way, precision medicine could serve as a useful tool to identify preclinical stages of disorders, make accurate diagnoses, and provide optimal treatments tailored to the patient rather than traditional treatments used at later stages of treatments [4].

Precision medicine also provides a major advantage when looking at the accumulation of knowledge. Researchers and doctors can learn from studying and targeting neurodegenerative disorders on a genetic basis. Precision medicine poses the possibility of creating a web-based network for neurodegenerative disorders that is critical for creating effective medicines for patients across specialized centers [5]. A terrific and successful example of a multi-disciplinary, web-based site is the Italian IRCSS Network of Neuroscience and Neurorehabilitation [2]. The main goal of this site is to focus on standardizing and enhancing patient care in the health system and creating therapeutic methods to treat neurodegenerative disorders.

The problem of neurodegenerative diseases becomes even more emergent as the population ages. Furthermore, the brain is an intricate organ with complex processes and, thus, it gives rise to complicated neurologic disorders. However, precision medicine is a promising tool that we should adopt in order to precisely assess and manage these disorders. Though there is still much to learn about precision, its implications could revolutionize treatment for neurodegenerative disorders.


Edited by: Priya Meesa

Graphic Designed by: Kidest Wolde


References:

[1] Ashley, Euan A. "Towards precision medicine." Nature Reviews Genetics 17.9 (2016): 507-\

522.

[2] Kovacs, Gabor G. "Molecular pathological classification of neurodegenerative diseases:

turning towards precision medicine." International journal of molecular sciences 17.2

(2016): 189.

[3] Strafella, Claudia, et al. "Application of precision medicine in neurodegenerative

diseases." Frontiers in neurology (2018): 701.

[4] Tan, Lin, et al. "Toward precision medicine in neurological diseases." Annals of translational

medicine 4.6 (2016).

[5] Twilt, Marinka. "Precision medicine: the new era in medicine." EBioMedicine 4 (2016): 24

25.


 
 
 

The Precision Medicine Initiative: What is it and should I care?

  • Abby Cortez
  • Mar 8, 2022
  • 3 min read

Precision medicine is rapidly becoming the focal point of modern medicine. Rather than using a ‘one size fits all’ approach based solely on past treatments for diseases, healthcare workers can now utilize new techniques to personalize medical treatment to the patients. And what’s the best way to personalize your care? Your DNA [3]. DNA is individual to each person, medical techniques can be studied and altered in a way that would take this individuality into account. All of this sounds great, and in many ways it is, but in order to achieve any sort of understanding about how our DNA responds to medicine, genetic testing needs to be conducted.

Genetic research is complicated. DNA is a very accurate personal identifier. Concerns about the ethics of genetic research are copious and nuanced. Researchers need to consider the effects their findings might have on the subjects’ mental health, familial relationships, decision to have children, life insurance, and even employment. On top of that, collecting enough samples from a population, usually a fairly specific population (ex. Women of Native American descent ages twenty to forty), can be expensive, time consuming, or nearly impossible, because of either limited access or distrust of the healthcare system due to a history of inequity and mistreatment in medical institutions.



To help overcome some of these obstacles and allow for precision medicine techniques to develop, the United States started the Precision Medicine Initiative. The goal being to help researchers work towards developing these new medical approaches within the country [1]. One of the major components of this initiative is the creation of a biobank. A biobank is a large collection of samples, in this case DNA samples, that are all stored and labeled together that researchers can be granted access to [4]. Many times patients donating these samples consent for their data to be used in a variety of projects, decreasing the number of consent forms the researcher may have to obtain since they can have access to already consented to samples. In the case of the Precision Medicine Initiative, they collect and store both health and personal history as well as DNA. Instead of having to collect a whole new set on their own, Researchers can be approved and granted access to these samples in order to conduct their research, making the process more efficient.

Of course, in order for this to work, Americans actually need to donate samples. Americans of all ethnicities, classes, and health levels need to be both aware of the initiative. This is in part why The National Institutes of Health gave it a second name: All of Us [2]. The use of the new title in advertising was an attempt to circumvent the fact that many Americans may not know what precision medicine is.

Participation in All of Us requires the donation of a lot of personal information. Such information is necessary for researchers to make accurate claims about their findings. However, due to the nature of this information, a lot of precautions need to be considered to protect the participants' data. One thing All of Us needs to consider is their privacy policies for data collection. Their security system encrypts all data and stores the keys in a separate system. They remove identifying information like name and address in an attempt to keep the samples as anonymous as possible [5]. They also have an access policy designed to ensure only vetted researchers have access to the samples [1]. Applicants go through ethics training, their procedures face review, and they have to sign many conduct contracts. The way they access and share the data is monitored, and the organizations seeking access must also have their own up to code data security system [5]. Even with all the safeguards, patients will still have to fill out a lengthy consent form and ensure they fully understand all the ins and outs of donating a sample.

Precision medicine is soon to be the gold standard for doctors, The Precision Medicine Initiative or All of Us, is extremely beneficial to American researchers in helping them refine techniques. The initiative has even created a database of information about the COVID-19 pandemic [6]. The more Americans know and understand about this biobank and its goals, the bigger it can grow and the more people it can help.


Edited By: Sam Shi

Graphic Designed By: Eugene Cho


References


 
 
 

DMEJ

   Duke Medical Ethics Journal   

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