Future of precision health - week 1

About 1-in-10 people over 65 have Alzheimer's disease. About 5 percent of people who have the disease inherit it from their ancestors, the vast preponderance or 95 percent of those stricken with the disease, get it "sporadically", meaning it's not inherited. The biggest risk factor is age. 

These numbers are only expected to get larger. In another year or so, only 2 percent of Medicare spending will go toward Alzheimer's disease. That number is expected to surge to 25 percent by 2040, as an estimated 28 million baby boomers are expected to have this disease. In that year, the last of the Baby Boomers will be around 74 years old.

In July, researchers gathered at the Alzheimer’s Assn.’s International Conference in Chicago and discussed how precision medicine is helping to deliver new treatments by making the clinical trials more "adaptive" by essentially assigning new subject recruits to the phases in the trial that show great promise.  

“Alzheimer’s disease trials need to evolve,” said James A. Hendrix, director of global science initiatives at the Alzheimer’s Assn. “We need to try new things and learn from other diseases,” he said. Delivering treatments for a select subset of patients “is an exciting new way to think about” new treatments for Alzheimer’s, Hendrix said. “Maybe one-size-fits-all is not the best approach.” 

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Obesity is not a government problem

If age is the biggest risk factor to getting Alzheimer's, obesity is a risk factor to getting Type 2 diabetes. 90 percent of diabetes cases are Type 2, which is strongly associated with obesity. And the annual cost of diabetes was $327 billion, according to the American Diabetes Association. The total impact of obesity and related complications is estimated to be between 4-8 percent of GDP, which, at the low end is comparable to the 2018 defense budget ($643 billion). 

This Op-Ed piece in the NYTimes - The toll of America's obesity - makes a good case for society to start eating healthy since a good diet can prevent obesity-related diseases. At the same time, this post falls short on approach and adds to this growing societal movement toward personal unaccountability. In this piece, the writer states, "Seventy percent of American adults are at least overweight, and body weight is strongly influenced by biology; we can’t blame individuals and expect personal responsibility to solve the problem. Instead, we need the government to pass a suite of policy changes to encourage healthy diets." 

I agree that we could use incentives that encourage healthy diets, though that could be fraught with a lot of conflicts. But we certainly can and should blame individuals as well. This is their personal responsibility. Obesity has become a bigger problem since the 70's and it's partly due to increased calories. According to the CDC, between 1971 and 2000, the average man added 168 calories to his daily intake, while the average woman added 335 additional daily calories.  

So what does this have to do with precision health? Apparently, the more we know our bodies, the better we can tailor the right diet and treatment. Andres Acosta, M.D., Ph.D. at the new Obesity Clinic in the Mayo Clinic Center for Individualized Medicine has developed an individualized approach to obesity. A study of 500 patients identified different factors leading to their obesity. They were then treated with more personalized approaches, which lead to losing two times more weight than with standard therapy. 

Read: Obesity: An individualized approach 

Read: Why people become overweight

Read: The toll of America's obesity

Gene test shows certain women can avoid chemotherapy

A study, called TAILORx, published by The New England Journal of Medicine, presented at a meeting of the American Society of Oncology in Chicago, showed that many women with early-stage breast cancer may not actually need chemotherapy, which is the current standard treatment. Genomic Health, a publicly-traded company focused on genetic research as it relates to cancer, helped to fund the study, which began in 2006.   

The study indicate that about 70 percent of women currently considered candidates for chemo could be spared from chemo. They would only have to take a drug that blocks the hormone oestrogen or stops the body from making it. 

Dr Larry Norton, of Memorial Sloan Kettering Cancer Center in New York, which participated in the study but did not fund or author it, said it's a "significant advance."

The gene test, called Oncotype DX Breast Cancer Assay, is the focus of the study. It is performed on tumour samples after surgery, to help determine whether chemo would help. The test is generally done for early-stage disease, not more advanced tumours that clearly need chemo because they have spread to lymph nodes or beyond.

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What is Pharmacogenomics?

Pharmacogenomics is the study of how genes affect a person’s response to drugs. This relatively new field combines pharmacology (the science of drugs) and genomics (the study of genes and their functions) to develop effective, safe medications and doses that will be tailored to a person’s genetic makeup.

Many drugs that are currently available are “one size fits all,” but they don't work the same way for everyone. It can be difficult to predict who will benefit from a medication, who will not respond at all, and who will experience negative side effects (called adverse drug reactions). Adverse drug reactions are a significant cause of hospitalizations and deaths in the United States. With the knowledge gained from the Human Genome Project, researchers are learning how inherited differences in genes affect the body’s response to medications. These genetic differences will be used to predict whether a medication will be effective for a particular person and to help prevent adverse drug reactions.

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(Image source: Channel5)