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   Duke Medical Ethics Journal   

Spring 2022 Blog Highlights
Morgan Robinson  •  February 14

"Precision medicine is medical care designed to optimize treatment of patients in certain subgroups, often using genetic or molecular profiling. This application of research has been expanded into many areas of healthcare and professionals study the genetics, environment, and lifestyle of a person’s own genes or proteins to prevent, diagnose, or treat diseases. Precision medicine has been successfully implemented with many more high volume diseases, such as diabetes and heart disease. However, only recently have efforts been made to expand into a more difficult area of medical research: rare genetic diseases. These diseases, such as Mitochondrial disease and Usher syndrome, can take much longer to diagnose and often result in an extensive diagnostic odyssey (period of attempted diagnosis from the onset of symptoms) which can involve many different professional visits and possible diagnoses. The time spent with painful medical procedures and practices to search for the proper diagnosis is lengthy. The potential application of precision medicine in this field could help alleviate this painful process as a diagnosis can lead to therapeutic and practical treatments for patients..."

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Camille Krejdovsky •  February 20

"Precision medicine often brings to mind a futuristic view of health care, in which therapies can be tailored to patients’ needs based on their lifestyle, genetics, and environment. While this form of medicine seems like an innovation that will be implemented far in the future, the fundamental ideas behind precision medicine are already playing out in society. Due to the delay in widespread integration of genomic data in health care, the private sector has taken matters into their own hands, offering what has been termed direct-to-consumer (DTC) genetic testing. While the term “DTC genetic testing” might be foreign, the idea is not. One of the most prominent examples is 23andMe, a company that allows consumers to pay for insights into their health and ancestry. The basic idea behind the DTC model is simple: consumers spit into a tube, mail it back to the company, and receive information back about themselves, ranging from diet recommendations to risk for certain diseases. However, the implementation of the model has proved to be much less simple, raising a variety of ethical and technical concerns..."

Annie Vila •  February 27

"Precision medicine has been a promising strategy to help eliminate disparities in healthcare involving race, ethnicity and gender. By providing patients with custom healthcare that focuses on their genetics, lifestyle and environment, treatments can become more effective by taking into account individual differences in health.

Despite the fact that there has been an ongoing initiative to assure proper treatment of racial and ethnic groups when dealing with precision medicine, there has been a noticeable lack of research regarding one minority group in particular: persons with disabilities. Considering that 26% of adults in the US have a disability [1], it is imperative to conduct sufficient research with persons with disabilities and include them in the ethical debate of precision medicine. There are several justifications for why people with disabilities need to be included in these conversations. Firstly, there are several disabilities with “genetic underpinnings” in which precision medicine can be employed so that the patient is receiving the best personalized care [2]. Additionally, people with disabilities are more susceptible to certain diseases than others; for instance, the risks of breast and lung cancers among schizophrenia patients are much higher compared to the general population [3]..."

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Heiley Tai •  March 8

"Prescription drugs are a vital component of treatment plans for complications and illnesses of all kinds; so much so that in surveys conducted by the CDC in 2015-2018, about half of all adults in the United States had used at least one prescription drug in the previous 30 days [1]. Treatment plans already imply some degree of individualization; medicine isn’t, and has never been, one-size-fits-all. Thus, pharmacogenomics aims to answer the question of how individual differences in the cellular mechanisms that respond to drug therapies affects the performance of those therapies..."

Abby Cortez • March 8

"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..."

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Kidest Wolde •  March 13
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"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..."

Nikhil Chaudhry  •  March 21

"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)..."

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Camille Krejdovsky •  March 21

"Since the completion of the Human Genome Project in the early 2000s, the field of genetics and genomics has rapidly expanded. As connections between genotype and phenotype were elucidated, companies arose offering to interface directly with consumers through the internet to give them information about their genomes. Because the industry and science developed rapidly, regulations around direct-to-consumer (DTC) testing developed as a reactionary mechanism. While this led to a piece-meal approach towards the regulation of a new industry, the resulting laws around the world are reflective of differing values and views of genetic information. As the world moves into the era of precision medicine, questions arise about what type of information should be released to patients, timing, and in what contexts. Laws around DTC testing have attempted to answer these questions outside of the healthcare setting and can provide perspective into the benefits and drawbacks of different approaches..."

Aaron Han •  March 21

"As healthcare becomes more individualized amid the pursuit for a “magic bullet”, there may be a day when the secrets of our genome have been elucidated and shared with healthcare providers. While our personal propensities to disease and unique responses to medication does not fully lie hidden in our A, T, C, and Gs (i.e., environmental and epigenetic factors contribute similarly), our genetic information undoubtedly influences our health outcomes. How will we uncover these predictors? One possibility is to genotype the entire population at birth, which already occurs in the United States for certain genetic, metabolic, and endocrine disorders.1 Indeed, from a purely medical standpoint, mass genotyping our population is useful, ensuring that patients receive appropriate treatment. Avoiding drugs that cause allergic reactions and matching blood types during transfusions appear routine to us yet are quintessential examples of the benefits precision medicine have in our world today..."

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Tochi Oneugbu •  March 21

"Precision diabetes medicine is a concept and practice that seeks to evaluate an individual’s behavioral, situational, and symptomatological differences to enhance the diagnosis, prevention, and treatment of diabetes. It uses precision diagnostics and precision therapeutics to treat patients with similar characteristics. It also uses advanced technology to observe disease progression. One way it differs from the standard practice used in place today is its usage of elaborate aggregated data to accurately diagnose an individual. Such data can originate from clinical or medical records, behavioral monitors, ingestible or wearable sensors, and genomic data. Due to the variability in diabetes subgroup types and the growing burden of disease in diabetes, precision medicine is necessary for the diagnosis and prevention of diabetes in individuals..."

Dhanasheel Muralidharan  •  March 29

With recent advancements in technology, the field of precision medicine has grown significantly, and healthcare workers have a new suite of technologies available for their usage. The concept of precision medicine takes into account countless factors about the patient in question and allows for a more personalized, targeted form of care. One field that precision medicine is already being used in is oncology, a field whose cases are highly-patient specific. This field serves as the prototype of how precision medicine can be used in other areas of medicine, and for better or for worse, will be the first field to face the ethical concerns regarding precision medicine.

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Meera Patel •  March 29

"What does it mean to be human? At the fundamental biological level, we all share a core set of DNA contained inside our cells, and the material held in these cells defines us as “humans.” In fact, we have over 30 trillion cells[1] in our bodies. However, it’s not just cells that reside inside of us–our bodies are also home to a vast array of microorganisms. These bacteria outnumber our cells more than 10 to 1[2]–so on a biological basis, we’re really more bacteria than human. Gross..."

Jondre Macaraeg •  April 6

"What is the best way to go about the biggest global health problems facing the modern world? Should we focus on the individual and make sure no one is left behind, just like the UN’s Sustainable Development Goals state, or should we try to focus on population health? This problem of efficiency and the methods of approach have been very prominent in global health since the inception of the field, but with the introduction of precision medicine, it makes the decisions for public health officials much more difficult..."

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