Drug Cures of the Future - Personalised Medicine
So...what exactly is personalised medicine, and how does this relate to drug treatment?
Well, it's just what it sounds like...medicine tailored to the individual; treatment that is specific to the person who is receiving it; use of treatment that is the most likely to result in a reduction of symptoms, a remission, or a cure.
OK, you might be thinking, but don't we have that already?
The answer to this question is no, in most cases we don't.
The Clinical View
Doctors prescribe drugs to alleviate or cure symptoms of disease. Unfortunately these symptoms are not always expressed as a result of the same cause.
Usually a restricted number of standard tests are carried out on a patient's blood and urine to provide an idea of what might be causing the problem. This list is limited, and of course means that there is no information on parameters that are not tested.
The clinicians have a set number of treatments to choose from. Their choice will be based on the data available at the time, and their experience with the disease (which may be limited). Of course there may also be other considerations like available facilities, funding and equipment, plus numerous practical considerations.
The Scientific View
Scientists have known for a long time that every person is different. Even though we categorise diseases into types and classes, the way that they affect each individual is different.
Rather than there being distinct diseases, there is a continuum of conditions - if you like, we may have separated out the colours, but not the shades. Each of the shades will respond differently to drug treatment and some will not respond at all.
The reason for the differences in disease expression between people, lies in differences in their genetic make-up, which together with factors from their lifestyle and environment provides a uniquely personal experience.
Because of these differences, people respond differently to treatments. Their response is not limited to effects that target the disease, but is also related to so called "off-target" effects i.e. patterns of side-effects.
The View of the Pharmaceutical Companies
Pharmaceutical companies are often cast as the evil villains in drug treatment, with their sole purpose being to make vast amounts of money. In truth their hands are becoming increasingly tied by pressures from investors, who provide millions of dollars for research and development programs without any certainty of a return.
The majority of drugs that have broad range applications, like Aspirin and Acetaminophen and many more have already been discovered. There are less and less drugs that can be prescribed to a broad range of people without someone having a reaction. Often this means drugs being withdrawn from the market, after being passed for use, due to one or two people experiencing reactions that were unforeseen.
Early stage drug testing requires testing in animals which have been genetically modified to be all the same. This introduces a couple of issues; one is that animals may not respond in the same way as humans, and the animals used are genetically almost identical (so that subtle variations cannot be tested).
Another issue is that when the drug goes into human trials it will be tested on a limited number of people. This means that maybe not all the possible adverse effects are accounted for. An additional problem is that a drug that may be extremely beneficial to a small sector of the population could get passed over, because only a very small number of people that would respond got to try it.
Bridging the gap
There are ways to bridge the gap and they will become increasingly prevalent in the future.
Gene sequencing is becoming cheaper and cheaper. Soon it will be possible for individuals to obtain screening almost routinely. Knowing a gene sequence can be helpful in determining what kind of treatments to provide for an individual patient. Naturally there are some ethical considerations to this approach, and it would likely be recommended that only the genes associated with the diagnosed disease or disorder be examined.
Another factor associated with genetics, and which is only really in the early stages of research is "epigenetics". This relates to changes in the control of your genes that are not directly related to the sequence. These changes are often caused by environmental and lifestyle factors (like stress) and can even be inherited.
A simpler method of providing more individual information with respect to a particular disease is to use biomarkers. These are chemical markers (like proteins) that can be tested for in blood in addition to the routine blood tests. Biomarkers provide more information on the "shade" of disease involved. Because equipment to test for biomarkers is improving all the time it's becoming possible to test for several of these indicators at the same time, using the same small sample of blood.
So what will the outcome of all this innovation be?
Use of specific medicines for specific types of disease in specific people will provide a reduction in overall treatment costs and wait times, because less time will be wasted using ineffective treatments.
There will be a higher percentage of sucessful treatment, and therefore more healthy people.
This reduction of trial and error in treatments, could especially be useful for mental illnesses which are notoriously varied in their responses to drug treatment, and a reduction in side-effects will increase compliance with medication routines.
It's as well to note that although the personalised approach to drug based medicine of the future is very promising we must not forget the "person"al approach.
Other patient centred approaches, that do not necessarily involve drugs, are also required for an improved medical system. Treatments like EFT, and therapeutic touch and increasing emphasis on supportive interdisciplinary programs are the way forward.