Technology has revolutionized everything from entertainment to work, with people increasingly personalizing various aspects of life to meet their needs. A similar trend is happening in medicine. More and more, healthcare is tailored according to our particular strengths and weaknesses. And while the term "personalized medicine" has a newfangled ring to it, this approach dates back to ancient times, when Hippocrates prescribed sweet elixirs to some and astringent ones to others, depending on each patient's particular characteristics [source: Scitable]. The modern version of personalized medicine is rooted in the same principles, and it's getting a lot of help from genetic technology.
In recent years, genetic research has improved our understanding of what it means to be human. This is partly due to the Human Genome Project, an effort by the U.S. government to identify the genes that make up human DNA [source: Oak Ridge National Laboratory]. Completed in 2003, the hope was that it would kick-start "genomic medicine," where healthcare would be delivered based on the characteristics of our genetic profile as well as our medical history.
Personalized medicine usually involves a combination of genetic testing (to determine propensity for certain diseases); suggestions for lifestyle changes; detection of diseases at the molecular level; and customized treatments for diseases, rather than a "one size fits all" approach [source: Personalized Medicine Coalition]. It is still in its infancy but is likely to influence traditional medicine more and more over time.
But how close are we to achieving the hope of molecular medicine? And how will genetic technology shape personalized medicine? Before we answer that question, let's weigh the pros and cons of knowing yourself on a genetic level.
If you could know what diseases you were likely to develop, would you want that information? This can be a tough question, especially when you consider that you might conduct your life differently if you thought you were likely to die young. On the other hand, knowing your risks may enable you to address problems before they arise, which can be life-saving. But how much can we rely on our genetic profile to tell us the true story of our health, when so much depends on things like diet, exercise, and lifestyle?
According to Dr. Howard L. McLeod of the Institute for Pharmacogenomics and Individualized Therapy at the University of North Carolina at Chapel Hill, these are important questions when you consider that most people don't know enough about molecular genetics to interpret such information. On the other hand, there is a lot to be gained from a person's genetic information, assuming that information is well-understood. In the future, this could happen with the help of some sort of counselor who would communicate the relevance of the genetic information.
The practical benefit of genetic technology for personalized medicine is that information in a person's genome may inform healthcare decisions, particularly the selection of certain drugs, says Dr. Geoffrey S. Ginsburg, Director of the Center for Personalized Medicine of the Duke University Health System.
"Healthcare providers can use genetic information to design medical plans that both maximize health benefits and minimize the risk of disease," he adds.
For instance, through genetic technology, researchers can identify which breast cancer patients will respond to certain drugs, sparing non-responders from the potentially severe side effects of an ineffective therapy [source: Scitable].
On the flip side, a potential hazard of using genetic technology in personalized medicine is that patients may receive incorrect information about their disease risks. Depending on the seriousness of the faulty data, this could cause significant distress for the recipient and, in some limited circumstances, raise issues of liability for those who provide the false information. According to Doriane Coleman, Professor of Law at Duke Law School, the potential for liability even if genetic reports are negligently produced depends on recipients being able to show that they'd been harmed in some way.
"Simply cutting back on cake in response to a false report that you're at risk for diabetes may not constitute an injury in the legal sense, but the emotional distress of wrongly thinking you're headed for an early grave could potentially open the door to legal action," explains Coleman." So far, there has not been any legal action in this area.
The question of whether to find out what our genes have to say is one that we all may face once genetic technology becomes more commonplace. In the next section, we take a look at where genetic technology is currently being used and what may come in the future.
Future of Personalized Medicine
One example of genetic technology that is already widely used in medicine is in prenatal care. During the first trimester of pregnancy, most American women undergo some sort of genetic screening for chromosomal abnormalities such as Down syndrome. It's based on a simple blood test. Genetic technology is also currently used to screen adults for certain conditions, including certain forms of dementia and Lou Gehrig's disease, though this is mainly in patients with a family history that puts them at high risk for these conditions [source: Oak Ridge National Laboratory].
In some cases, genetic technology can also tell us how patients will respond to traditional therapies. Dr. Ginsburg notes that genomic information can help ensure that patients are getting the right medications and in some cases the right doses of medication based on DNA analysis.
Despite these technological advances, widespread "genomic medicine" has yet to be realized. According to Dr. Paul Doghramji, a family physician in Collegeville, PA, patients are increasingly interested in genetic technology, but the science hasn't quite caught up in terms of practical application.
"Most basic health screening is still done by talking to patients about their personal and family medical history," he says.
This is partly because diseases often arise from the interaction of multiple genes, with at least some input from the environment. These interactions limit the utility of genetic technology in personalized medicine, at least until gene-gene and gene-environment relationships are better understood in the human context.
- Coleman, Doriane. JD. Personal communication. Oct 6, 2011
- Doghramji, Paul. MD, FAAFP. Personal correspondence. Oct 6, 2011
- Ginsberg, Geoffrey. MD, PhD. Personal correspondence. Oct 6, 2011
- McLeod, Howard. PharmD. Personal communication. Oct 6, 2011
- National Human Genome Research Institute. "Genetic Information Nondiscrimination Act of 2008." Accessed Oct 6, 2011) http://www.genome.gov/24519851
- Oak Ridge National Laboratory. "About the Human Genome Project." (Accessed Oct 6, 2011) http://www.ornl.gov/sci/techresources/Human_Genome/project/about.shtml
- Personalized Medicine Coalition. "What is Personalized Medicine?" (Accessed Oct 6, 2011). http://www.ageofpersonalizedmedicine.org/objects/pdfs/Age_PM_factsheet.pdfPray, Leslie. "Personalized Medicine: Hope or Hype?" Scitable. (Accessed Oct 6, 2011) http://www.nature.com/scitable/topicpage/personalized-medicine-hope-or-hype-815