The Personalized Medicine Revolution: How Diagnosing and Treating Disease Are About to Change Forever
176
The Personalized Medicine Revolution: How Diagnosing and Treating Disease Are About to Change Forever
176eBook
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Overview
In this persuasive and compelling book, Pieter Cullis argues that personalized medicine, also known as precision medicine, is the biggest revolution of our time. By replacing the current one-size-fits-all approach to medicine with medical treatment based on a patient’s unique molecular makeup, personalized medicine will radically change the role of doctors and patients and even the future of our species. Increasingly, instead of focusing on the treatment of chronic diseases, as they do today, doctors will focus on helping people prevent disease. The end result will be to dramatically extend and improve our lives, creating a minefield of practical and ethical issues. Written in clear, accessible language, the book explains what personalized medicine is, how it will change healthcare, and what it means for humanity’s future.
Product Details
| ISBN-13: | 9781771640398 |
|---|---|
| Publisher: | Greystone Books |
| Publication date: | 02/10/2015 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 176 |
| File size: | 279 KB |
About the Author
Read an Excerpt
From the Introduction:
A black man, a Japanese woman, and a Mohawk man walk into a doctor’s office.
The setup to an offensive joke? Well, maybe—but it’s also the premise of this book. All three of these patients have the same problem—high cholesterol—and the doctor writes each patient the same prescription for statins, right down to the dosage. Statins, hailed in the last decade as a kind of wonder drug for cardiovascular disease, have been found to reduce the risk of a heart attack by 54 percent and the risk of a stroke by 48 percent, and some studies suggest they may also help prevent dementia and prostate cancer.
The problem is that the African-American man, Sam, metabolizes the drug too quickly: his body breaks down the medication before it even gets a chance to work, and his cholesterol stays high, putting him at risk for heart disease and stroke. The Japanese woman, Mieko, has the opposite problem: her body metabolizes the drug too slowly, and it lingers in her body, lowering her cholesterol but also causing her all sorts of uncomfortable side effects, including headaches and insomnia. Most unlucky is Joseph, the Mohawk man, who suffers a rare but serious reaction to the drug, statin-induced rhabdomylosis, a debilitating form of muscle damage. He is hospitalized for weeks and just barely manages to avoid kidney failure.
These kinds of scenarios are unfortunately rather common: every year over 2 million North Americans are hospitalized, and more than 100,000 lose their lives, because of adverse reactions to drugs—tragic cases of the cure being worse than the disease. They remind us that who we are—our age, our sex, our size, our ethnic heritage—matters to our health. Shouldn’t our medicine be tailored to our differences?
As it turns out, medical science is headed in that very direction. In fact, we are nearing the biggest revolution of our time—perhaps of all time. The revolution has many names and guises, sometimes called personalized medicine, sometimes precision medicine, sometimes stratified medicine. It is a cousin of “evidence-based” medicine, a relatively new concept in medical practice. Makes you wonder what doctors relied on before. In any event, what we will call personalized medicine, which is medicine based on the unique molecular makeup of you as an individual and whatever disorder you may have, is on our doorsteps. It will satisfy needs that humans have been seeking for millennia, and it will mean that, once and for all, we will leave the natural evolutionary processes of our ancestors for a self-directed future.
We tend to view medical progress as some sort of continuum, where we develop better drugs to fight whatever diseases are prevalent, better machines to image our insides and to detect problems, better devices to aid when joints wear out or eyes fail, better ways to treat pain or depression or loneliness, and we might be inclined to believe that the future holds more of the same. But it is not going to be that way. Medical progress to this point has largely been based on advances that benefit the population as a whole rather than you as an individual. Two hundred years ago the average lifespan in North America was only about forty years, largely because two-thirds of all children died before the age of four. Public health initiatives leading to adequate diet and clean water have had a huge impact, and they, combined with population-wide advances such as vaccination, sterile procedures during childbirth and surgery, and antibiotics to treat bacterial diseases mean that the average lifespan today is about eighty years or more. But population-based approaches to maintain human health and life have begun to fail.
The most obvious way things have begun to fail is in the development of drugs. When Paul Ehrlich discovered Salvarsan, a drug to treat syphilis, in 1909 and introduced the concept of the “magic bullet” to cure our various ailments, and Alexander Fleming followed up with the discovery of penicillin in the 1928 to cure a wide spectrum of infectious diseases, we became seduced by the notion that other compounds could be found that would have similar magical effects on other diseases, ranging from cancer to the common cold. An enormous industry, the pharmaceutical industry, sprung up as a result, and there are now about a thousand commonly prescribed drugs to treat almost every disease you can name. The average family doctor writes over twenty thousand prescriptions of these drugs every year. This practice has led to alarming levels of medication, with approximately 20 percent of North Americans over the age of 65 taking ten or more drugs every day. As a direct result, the fourth-leading cause of death in North America is a bad reaction to a drug or drug regimen. Further, researchers estimate that 90 percent of adverse drug reactions are not reported, so the negative effects could well be higher.
There are other problems. For “blockbuster” drugs, such as the statins to treat high cholesterol and the ACE inhibitors to treat high blood pressure, in order for one person to benefit and not have a heart attack or stroke, more than one hundred people need to take these drugs every day for their whole lives. In other words, 99 percent of people taking these drugs get no benefit at all and are likely to suffer some side effect. Over 50 percent of prescribed drugs don’t work on the person they are prescribed for. The combination of all these problems has made drug development an almost impossible task: getting a drug approved now costs over $1 billion and may take more than fifteen years, and even then some adverse reaction in a small subset of people may cause the drug to be withdrawn.
There are serious problems even with drugs that do work. One of the first major successes of cancer chemotherapy was in treating childhood leukemia. In 1950 a diagnosis of leukemia in childhood was an almost certain death sentence, with over xx percent of children dying within a year or less. In 2012 the “cure” rate—or the number of patients who remain cancer free for five years after treatment—for acute lymphoblastic leukemia, the most common type of childhood cancer, was over 90 percent. But these survivors do not lead normal lives. Over 30 percent of children treated with the most effective drug “cocktail” go stone deaf, permanently. The costs are immeasurable, emotionally damaging, career limiting. The costs to society are daunting: over $20,000 per child per year until adulthood to provide special resources. Other “side effects” include infertility, retardation—the list goes on and on. And this is not an isolated example. The common chemotherapy protocol for treatment of solid cancers in children uses a drug that can harm the heart. It is not unusual for a child being treated for such cancers to go into heart failure as a result of chemotherapy, requiring a heart transplant. More often the effects of a weakened heart are apparent through the survivor’s lifetime.
Although medical science has made some impressive strides in the past few decades, we still face major obstacles such as these. Doctors have trouble detecting many types of cancer—including pancreatic, lung, and ovarian cancer—in their early stages, when they are easiest to treat. And patients with chronic pain conditions don’t have many options to manage their symptoms; the anti-seizure and antidepressant medications that doctors prescribe give mixed results at best. These problems come from our one-size-fits-all approach to medicine based on trial and (sometimes fatal) error. To break through these barriers, we need an approach that takes into account individual differences in the way we react to the environment, food, drugs, disease, and trauma. The medicine of the future is going to be much more individualized—designed for you and the body you inhabit.
Some aspects of medicine have always been more personalized than others. For example, physicians have long recognized that prosthetics must be tailored to the person. Even the relatively primitive prosthetic leg that Terry Fox used in his Marathon of Hope to raise awareness and funds for cancer research had to be specially made to fit his height and amputated leg. Prosthetics have come a long way in the four decades since. Imaging and 3D printing technologies are allowing prosthetics from artificial limbs to replacement knees to be customized to the patient for function or aesthetics. Taking that level of customization down to the molecular level—responding to each individual’s unique biochemistry—is the overarching goal of personalized medicine.
One day, a visit to the doctor will look very different: Each of us will be able to afford getting our genetic code sequenced. Maybe we’ll store it in a personal health record in the cloud and bring it up on our smartphones at our checkups. Knowing what genetic mutations and variations we carry around in our cells, the doctor will not only be able to tell us how likely we are to develop depression or diabetes or liver cancer but also prescribe drugs that we can be sure won’t hurt us, at a dosage that will be just enough to treat the disease. By getting a profile of the proteins in our blood, we’ll know the state of our health—how our bodies are reacting to an injury or a drug—and we’ll be able to adjust quickly as needed. Maybe we’ll have simple breath tests we take every morning that will give us a real-time picture of how well the liver, pancreas, or digestive system is working—or even a device we can wear that acts as a kind of black box for our bodies, keeping a long-term record of our health.
This future isn’t far off: we’ve already seen promising advances in gene-based therapies—from lung cancer treatments that target a specific kind of tumor to drugs that drastically improve the quality of life of patients with genetic diseases like cystic fibrosis. With the recent growth of exciting gene sequencing and diagnostic technologies, these examples are mere glimpses of a coming sea change in the way we detect and treat disease. Through the stories of the researchers, physicians, and patients behind these breakthroughs, we’ll see how we are building a revolutionary new approach to medicine.
Table of Contents
IntroductionI Molecular You
II At the Dawn of a New Age
III Personalized Medicine’s Promise
IV The Bigger Picture—and the Perils of Personalized Medicine
V The Road Ahead
Notes
Recommended Readings
Index