Anyone in the field of health care or observant of patient’s clinical course knows how patients often dramatically differ in their response to prescribed therapy. We have ascribed this to a variety of factors, some assumptive and some ascribed to “biological variability” represented within populations. We construct randomized clinical trials with large, diverse populations to assess responses to a drug versus another drug or placebo in order to figure this out.
The unlocking of the human genetic code has given some insights into what the future of medicine will bring to understand this variability.
The variability we see is locked inside of you, all of you.
The field developing around this very complex science is termed “precision medicine,” often referred to as “personalized medicine.” On a simple level for a few conditions, a gene, the code of our genetic structure, may determine if an individual responds to a medication or not.
Most conditions are not that easy. Multiple genes, working in concert or opposing one another, influence the production of disease or the responses to the disease with the therapies we provide. Some genes are active, producing proteins that affect this process and some remain inactive. In conditions such as cancer, mutations, where the genes go haywire, play major roles in the creation of disease as well as the receptiveness to treatment.
To understand this takes an enormous amount of information about patients and the conditions they acquire. This is a detective mission, first to determine what genes are involved, how they act to develop who we are, how they become altered and create disease states, and how they may respond to treatment.
So understanding all about you requires us to know a lot about all of you.
We have reached a point of understanding that has shown some cancers appearing in different organs, say lung and skin, carry the same mutations leading to this disease. Ideal treatment may be more likely based on the same mutations rather than what works in other cancers of the same organ.
Imagine a multidisciplinary cancer clinic based on “XYZ” mutation rather than the organ of disease origin.
We have reached the point in our technology that we can gather an enormous amount of patient data and manage this with powerful systems. We have technology that can map the entirety of an individual’s genetic structure or specific genes of interest in a fast and cost-efficient manner.
Putting this all together is the work of many scientists and clinicians around the world, including some at Henry Ford Hospital. We recently commissioned a Precision Medicine Task Force lead by Drs. Steven Kalkanis and Richard Zarbo, to explore what is needed to forward this science and bring it to the care of patients. Our executive leadership approved funding for ongoing work in this area that will be used to support the infrastructure required to map the genes and manage the information collected.
We see a future in which the genetic profile for diseases will be imbedded within the medical record, similar to other laboratory studies.
We have a long way to go in this area. When it fully hits patient care, we will need to have as much emphasis of counseling patients and families about the information about their unique genetic codes as we will for the indications and risks involved in treatment.
That being said, the promise is exciting, not only for cancer care but for treating all diseases, both common and uncommon. It is the full expression of our commitment as a system, “All for you.”