By: Michelle Ngan
In the State of the Union address earlier this year, President Barack Obama announced a precision medicine initiative that is changing the way we think of research. This new method has the potential to revolutionize current approaches and treatments for a variety of disease.
In a January 30th speech at the National Institute of Health (NIH), President Obama described his precision medicine initiative as a plan “that brings America closer to curing diseases like cancer and diabetes, and gives all of us access, potentially to the personalized information that we need to keep ourselves and our families healthier.
According to the NIH, the definition of precision medicine is “an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person.” However, while the name “precision medicine” suggests individualized care of patients, Obama’s initiative instead focuses on developing treatments for patients with different subgroups of a disease using genetic information.
The use of genetics as a treatment for disease is a relatively new technology; it gained momentum with the Human Genome Project, completed in 2003, an international effort to map the entire human genome sequence. Much of the existing research on precision medicine using genetics currently focuses on the treatment and prevention of different cancers. The Cancer Genome Atlas, a project under the National Cancer Institute (NCI), has sequenced the genomes of nearly thirty forms of cancer through analysis of tissues samples.
In the NCI’s 2014 article, “Precision Cancer Medicine: The Future is Now, Only Better,” Schilsky and colleagues determined that targeted therapy of various cancers resulted in positive responses from patients with metastatic cancer, or cancer that has spread from the point of origin to other places of the body.
President Obama’s initiative would, among other goals, continue funding cancer research, particularly studies that focus on genomic mapping in relation to different types of cancer. Of the $215 million delegated to the plan in the president’s 2016 proposed fiscal budget, $103 million would go towards a research cohort, $70 million to the NCI, $10 million to the Food and Drug Administration, and $5 million to help “sync” preexisting genomic databases.
The largest project being funded by the precision medicine initiative is a nationwide research cohort, which would map out the genomes of one million volunteers, gathering biological specimens and testing new drugs and devices. According to the American Association for the Advancement of Science, the research cohort will include both healthy and sick individuals from pre-existing studies in an attempt to better represent the general population. It will also bring focus to patient privacy and health information systems; research volunteers will be able to view their health records, as well as view who is accessing their records.
In The New England Journal of Medicine, NIH Director Dr. Francis Collins and NCI Director Dr. Harold Varmus wrote, “Such a varied array of research activities will propel our understanding of diseases — their origins and mechanisms, and opportunities for prevention and treatment — laying a firm, broad foundation for precision medicine.”
While this initiative has garnered the support of many researchers, others have voiced their concerns about the plan for various reasons.
Cynthia Graber, writing for The New Yorker, wrote that the problem lies with the doctors and their unfamiliarity with applying genetics to patient treatment.
“Part of the dearth of genetics expertise among physicians stems from the fact that many of those currently practicing went to medical school before the human genome was sequenced,” she wrote in a February article titled, “The Problem With Precision Medicine.” In addition, she noted that “general-care physicians seem to understand that their lack of training is a hindrance,” citing a 2014 study in Genetics in Medicine that found that many respondents “expressed reservations about not fully understanding test results or not being able to devote the time necessary to discuss testing options and outcomes with patients.”
In her Forbes article “Obama’s Not-So-Daring Precision Medicine Plan”, Meredith Salisbury was critical of another aspect of the initiative, believing that the funding allocated to the initiative would not be sufficient to execute the program as well as President Obama wished.
“For an area of medicine that promises to be critical in delivering better healthcare to patients,” she wrote, “the plan should have been bigger and more ambitious.”
The success of the new precision medicine plan remains to be seen, as President Obama submitted a request to approve the budget late January. If approved, those involved remain optimistic that it will change the current state of medicine.
“With sufficient resources and a strong, sustained commitment of time, energy, and ingenuity from the scientific, medical, and patient communities,” Collins and Varmus wrote, “The full potential of precision medicine can ultimately be realized to give everyone the best chance at good health.”