Precision medicine - more laser or shotgun?

Is precision medicine misleading the public and what does precision medicine mean for your health?

Welcome to another week of Precision Health weekly, where I look around the web to collect interesting stories about this promising segment of healthcare. 

Admittedly, the more I read about precision medicine, the more I want to write a headline that says: Precision Health - are we there yet? 

As parents know, this repetitive, and sometimes annoying while endearing, question (often asked in 2-minute intervals) reflects a child's concept of time, or lack thereof, and implies the trip is taking forever, even though it's probably a 30-minute ride.

In like vein, the promise of precision health appears at our reach. We're making progress. As this post proclaims "The evidence is compelling. Precision medicine is gathering momentum."

Then I read stories like this NY Times Op-Ed: "Are we being misled about Precision Medicine" and question if we have the right directions. Critics call genetic testing pseudoscience, pointing to Soccergenomics as the poster child of absurd claims. The website says it can "improve performance through genetics" and "unlock the player within you." 

The author of this piece: Scientists push back against booming genetic pseudoscience writes: "In case it’s not clear, there is still no way to decode from DNA the perfect plan to turn your 7-year-old into a soccer star."  

If Gertrude Stein had an opinion, she might say: "There is no there there." And maybe Ted Kruz would call the current crop of tests a bunch of nothing burgers. 

Well we can look at the glass half empty, or half full. So let's hope that we are making progress and the tests and solutions will get better. Otherwise we'd just be like Jack Black in Nacho Libre searching for the next eagle egg to give us eagle powers. 

With that, here's some interesting posts for the week.

Don't forget to join me and my co-hostesses Dr. Archana Dubey (HP Global Medical Director) and Fran Ayalasomayajula (HP's Population Health Innovation Lead) at our upcoming SplashX Invent Health salon focused on Precision Health. Check it out here. 

Speakers include: Chris Glode from Helix, Atul Butte from UCSF, Jeffrey Brewer from Bigfoot Biodmedical, Risa Stack from GE Ventures, Amy Raimundo, from Kaiser Permanente Ventures and so many more.

What does precision medicine mean for your health?

Worth-a-read outline by the CDC (Center for Disease Control and Prevention) about how precision medicine relates to our health. First the CDC's definition of precision medicine is: an approach for protecting health and treating disease that takes into account a person's genes, behaviors, and environment. The only way to take these factors into account is to collect the data, organize it and use it.  

The CDC mentions using your family history as a way to get more precise treatments and/or recommendations. This is something we already collect, for those who see their physicians, and recalling filling out pages of information about yourself and family members. But if you're like me, and you've changed physicians recently, you might wonder where this information lives and whether or not you're taking the best steps to prevent diseases you're predisposed to getting. Note to self: Ask you doctor next time you visit. 

The CDC also recommends getting genetic tests, at the least to determine whether you have certain genes that may or may not respond to certain treatments. 

Finally, if you want to contribute to this movement, join the All of Us research program, led by the National Institutes of Health. By joining you agree to contribute information about yourself which will be analyzed to see how genetic, behavioral and environmental factors affect health, including likelihood of getting diseases and the efficacy of preventions and interventions. 

Read more.

Are we being misled about precision medicine?

“You think it’s going to be more precise, like a laser versus a shotgun. But it’s still a shotgun," said Scott Primiano, whose wife died at 59 from breast cancer. "She believed in it [precision medicine] wholeheartedly," he told the NYTimes. The Times story is about MaryAnne DiCanto, who believed that doctors could match her with the right prescriptions based on her genetic mutations in her tumors. She went through biopsies to identify the therapies that might help. She took an experimental drug, but it didn't help. According to her husband, standard treatments worked, but none of the targeted therapies recommended through the genetic tests helped. The article then states that there are more deaths and success is rare. 

This is a good quote from the piece from Dr. Nikhil Wagle, a cancer specialist at Dana-Farber Cancer Institute in Boston, who helps develop precision-medicine tests. “There are very few instances in which we can look at a genomic test and pick a drug off the shelf and say, ‘That will work. That’s our goal in the long run, but in 2018 we’re not there yet.”

The opinion piece also notes that a study published in Cancer Discovery, showed that precision medicine failure rate across 1,000 patients was 93 percent! 

Read more.

Image sources: Quest Diagnostics, Geneticliteracyproject