A personalised feature of future medicine
This post is by Tinku Singhal, founder of Innoshiksha.
Lot of research is in progress to enhance the efficacy and safety of medicine and despite the several efforts, this is being the greatest challenge for the researchers and pharmaceutical companies owing to the complexities involved in it. This challenge gave rise to the new field of medicine, called personalised medicine. Personalised medicine will target the disease based on patient’s unique clinical, genomic identity in accordance with informed environmental conditions. So, they can be regarded as right medicine for right individual, for right disorder with right response. Because of these many praiseworthy properties, personalised medicine became matter of discussion and area of research from late nineties.
Though personalised medicine provides great benefits, there is great challenge ahead to develop them. As 2004 Nobel laureate Aaron Ciechanover, rightly pointed out, it requires development of advanced technology that can enable us to sequence and process the individual genome data in a few hours at low cost. The completion of Human Genome Project in 2003 along with notable developments including next-generation sequencing platforms, miniaturisation of devices and enhanced electronic data storage and handling capabilities boosted the pace of developments in the field of personalised medicine. But these technological advancements helped research but not the clinical practice.
Illustration by Zhou Tao (ShanghaiDaily.com)
Apart from technology, other challenges include the development of new biological markers (biomarker for diseases, drug targets, toxicity and efficacy), drug targets and development of mechanism based novel drugs for these targets. The relation of change in genetic profile (mutation) with the outcome is not straight as it was thought to be. It is difficult to predict as environmental factors also contribute to the outcome of mutations. So, systematic identification and classification is required for having predictable outcome. Development of personalised medicine can also lead to bioethical problems, here technology can play critical role by ensuring privacy and protection of individual’s genetic information.
Despite of numerous efforts to rationalise the use of pharmaceutical medicine and giving creditable emphasis to personalised medicine, it fell behind expectations in its progress. The reasons for this failure are multiple, so the multidisciplinary approach towards it can only be solution for it. We need consistent and sincere research in the biological field as well for the relevant technological advancement. So, adequate and consistent funding from government and other bodies should be available to the able scientists. Collaborative approach is essential for development of personalised medicine owing to its interdisciplinary nature. Various research groups should be formed at national and international level to accelerate the progress in this field.
Technology and personalised medicine will be of no use if they cannot be handled and administered properly. Clinical practices need to be redesigned and improved for better applications of technology available and proper administration of medicine. Training and education about the technology and targeted therapies should be imparted to physicians. They should be able to diagnose patient and relate the clinical information with the genetic profile of the patient. Medical schools should include effective genetic courses in their curriculum for this purpose with specialised training to students.
Since, this new field of medicine involves bioethical issues, so it requires careful and well planned progress. Awareness should be spread among the common people and level of literacy should be raised, especially in developing countries like India. Proper studies, surveys should be there with well-maintained medical information. Individual should be provided support of proper legislations. One such step has been taken in U.S., as it passed Genetic Information Nondiscrimination Act (GINA), 2008. It protects citizens against the discrimination in health insurance and employment based on their genetic information so that they can take full advantage of personalised medicine. Such Acts are required in other countries and at international level.
Major pharmaceutical companies should come forward to facilitate research and in lowering the cost of personalised medicine as these medicines also bring economic benefit to them by reducing the risk involved in the clinical trials. In addition, it will also reduce the withdrawal of medicine from market and of undesired litigation. So, it will bring benefits to all, producers as well as consumers.