Precision Medicine: Promises and Controversies
In his January, 2015 State of the Union Address, President Obama announced the Precision Medicine Initiative, a “bold new research effort to revolutionize how we improve health and treat disease.”1 This ambitious project is poised to revolutionize how medicine is researched and practiced in the United States. However, it is not without controversy, and a host of details must be addressed for the initiative to be successful.
To shed further light on this complex topic, MPR interviewed Cheryl Pegus, MD, MPH, Clinical Professor of Medicine and Population Health, Director, Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, New York City.
What is precision medicine?
I like to describe precision medicine as “genetics +” It is the tailoring of a treatment to the individual characteristics of each patient or group of patients. It takes into account multiple factors beyond genetics, including environmental, lifestyle, and biometric information. These are used to inform recommendations for prevention and treatment of disease.
One of the problems that contributes to current healthcare not achieving high quality, cost-effective outcomes is that everyone with the same condition is being treated the same way even though there are differences amongst people. The reasons for the success or failure of a given treatment are therefore unclear, is it the treatment or individual factors of the patient? Precision medicine seeks to clarify what will and will not work based on multiple factors, and design treatment plans accordingly.
For example, the treatment of a New Yorker with hypertension may need to be different from the treatment of a person who lives in a remote rural community. Sodium intakes, real-time tracking of exercise levels, and genetics differentiate these two individuals, remote monitoring of blood pressure and healthcare feedback allow us to tailor treatments. And even if the genetic profile is similar, taking all the factors into account enables more precise targeting of the patient's needs for prevention and treatment. Precision medicine utilizes and synthesizes data that individuals generate themselves.