What if your genetic makeup could help to improve your medical treatment? Personalized medicine makes this possible. In a world plagued by so many devastating diseases, a more effective way to treat and prevent them is nothing short of an extraordinary breakthrough. While personalized medicine is in its beginning stages, it is projected to be driving the medical field within the next few years. Many scientists believe that personalized medicine is the future of our healthcare system and the solution to the problems our healthcare system faces. Currently, the healthcare system in the United States is centered around a one-size-fits-all approach, which has negative implications for both patients and physicians. One of the biggest problems patients face today is the ineffectiveness of medicine. Personalized medicine, also known as precision medicine, determines treatment by studying an individual’s specific genetic makeup. This approach to medicine aims to treat complex diseases such as cancer, heart disease, and diabetes. The goal of personalized medicine is to provide the right treatment, to the right patient, at the right time. An increased understanding of an individual’s genome results in more knowledgeable medical decisions, as the physicians are more aware of the specificity of each disease. With the ability to target specific genes, treatments become more effective with fewer negative implications. As a country, our public health system has emphasized a shift towards preventing diseases, not simply treating them. Personalized medicine offers a way to make this shift, as it allows preventative measures to be taken based on genetic susceptibility. 

For some, however, the prospect of personalized medicine is not so promising. Physicians fear that the name “personalized medicine” is dangerously misleading. Many physicians in opposition to this paradigm shift argue that truly personalized medicine is not possible, and mislabeling medicine may lead to false hope. Politicians feel that the national implementation of personalized medicine would result in ethical consequences much larger than we can imagine. Some patients pose questions of what to do with unwanted genomic information, while others fear it is a gateway towards genetic engineering. There is also controversy surrounding the cost of personalized medicine. Many patients who feel treatments should be tailored to the individual, often fear the cost of developing individualized drugs. Patients also worry that any genomic information that indicates a higher risk of developing a certain disease will be misused by insurance companies, driving monthly premiums through the roof. In addition to insurance concerns, patients feel that a personalized approach to medicine is only beneficial to the sick.

 Despite the controversy, the benefits that personalized medicine offers outweigh the risks. The issues presented by those opposed to personalized medicine can all be solved through regulation and understanding. There is much room for improvement in the current United States healthcare system, and personalized medicine offers this improvement. Personalized medicine should be implemented on a national level, as it would result in more knowledgeable medical decisions, place a focus on preventative care, and increase the probability of optimal treatment outcomes.

Personalized medicine takes into account that each person has unique clinical, genomic, and environmental information. Due to these differences, diseases vary among individuals. Personalized medicine is an approach to healthcare in which medical decisions, treatments, and practices are molded to individuals based on their genomic information and predicted responses. U.S. News and World Report Health describes the human genome as “the blueprint for each person’s body, influencing how we look, our genetic predispositions for certain medical conditions, how well our bodies fight disease or metabolize food, and which therapies our bodies do and do not respond to.” Now it is understood that the human genome consists of both genes and DNA. DNA is comprised of four chemical bases, known as A, T, C, and G. The unique pairings of these bases determine the organism that develops. Unfortunately, genomic information has not always been readily available in the field of healthcare. In fact, access to genomic information is a relatively new breakthrough. In 1990, the Human Genome Project was launched with the goals of identifying the makeup of the human genome and pinpointing specific genes that caused common diseases. After more than a decade of research, the Human Genome Project was completed, and the 3 billion chemical bases of the human genome had been identified (“Personalized Medicine”). Through the information gathered by the project, scientists now believe that many diseases and predispositions stem from multiple-gene interaction. This information was later applied to personalized medicine and genomic testing. 

The term “personalized medicine” was first featured in published works in 1999 (Pucheril and Sharma).  Since the term’s first introduction, personalized medicine has been impacting how people view healthcare. In 2007, Science magazine named the genomic discoveries made by the Human Genome Project the “2007 Breakthrough of the Year” (“An Expanded Timeline of Personalized Medicine”). In the years following, studying the human genome gained more traction. Personalized medicine was changing the way that patients with breast, lung, and other cancers were treated. These changes in treatment, however, did not stop with cancer. Genetic information was also used to identify the best anti-depressants for patients struggling with mental illness. In 2015, personalized medicine got the recognition it deserved, however, this recognition came under a different name—precision medicine. Then president, Barack Obama, launched the Precision Medicine Initiative in his 2015 State of the Union Address, an initiative which aimed to “revolutionize how we improve health and treat disease” (“The Precision Medicine Initiative”). In December of 2015, Obama signed legislation that provided over $200 million for the recently announced initiative. This initiative worked in conjunction with the Department of Veterans Affairs, the Department of Defense, the Food and Drug Administration, the Department of Health and Human Services, and the National Cancer Institute in order to deliver more effective prevention and treatment options for patients. In addition to these organizations, over forty private-sector organizations have committed to implementing precision medicine in accordance with the key principles of the initiative (“Fact Sheet”). The former President of the United States, as well as the companies listed above, see the promise in a healthcare system centered around personalized medicine. That being said, the funding personalized medicine has received and the companies that support a system-wide shift, are not enough to result in a complete transition to personalized medicine. Though the shift towards precision medicine has begun, the vast majority of healthcare facilities around the country do not yet offer personalized treatment for patients. Patients have a large role in altering the current healthcare system and must show providers they support the change to personalized treatment. 

Like any new initiative, the national attention given to precision medicine was met with some opposition. Questions were raised about storing the genetic information of millions of people, as well as the privacy, ownership, and abuse of that information. “How will we store the data collected through genomic testing? Will this data be stored privately and securely enough that it is not vulnerable to cyber-attack? How do we prevent misuse of this genetic information?” In addition to these questions, many worried about increased healthcare costs as a result of the initiative. To this day there is much controversy over personalized, or precision medicine, however, with the few downsides come the overwhelming benefits. 

The current approach to the United States healthcare system focuses on treating diseases that patients already have. One of the most important goals for public health by the year 2020 is to shift from treating diseases to preventing them. Personalized medicine provides our country with the means to make this shift. Preventative medicine is based on information that is both predictive and actionable, either before a disease occurs or in its early stages (Khoury, et. al.).  Many of the disease that plague Americans each year are preventable. According to the Centers for Disease Control, chronic diseases are responsible for seven out of every ten deaths among Americans each year and account for seventy-five percent of the nation’s healthcare spending (“Preventive Health Care”). Genomic and genetic testing associated with personalized medicine allow for screenings that provide insight on susceptibility to these chronic diseases, allowing physicians to suggest lifestyle changes or better monitor diseases patients are more likely to develop. Identifying patient risks and making effective changes results in a healthier population, and can help to reduce healthcare spending for both patients and the nation. 

One of the best examples of genomic testing being used in preventative care is work being done with BRCA genes. Knowledge of mutations on these genes can be linked to breast and ovarian cancer, allowing physicians to determine those at a higher risk of developing these cancers. Up to ten percent of breast cancers in the United States are linked to an inherited gene mutation, most of which are on the BRCA gene. These gene mutations--BRCA 1 and BRCA 2--were discovered in 1994 and 1995, respectively (“Testing for BRCA”). The Susan G. Komen foundation recommends that those who have family or personal history of breast cancer, ovarian cancer, or male breast cancer be tested for the genetic mutation. There are many clear benefits to getting tested for these genetic mutations for those who fall under the above criteria. Negative results leave the patient with relief about their risk of developing breast or ovarian cancer, while positive results give the patient options to move forward, and reduce their risk of developing those cancers. Patients have the ability to speak with genetic counselors and discuss the possibilities of risk-lowering drugs, and preventative procedures (“Testing for BRCA”). Though a positive result may be hard for patients to come to terms with, genetic counselors can help patients explore their options and discuss the feelings they have surrounding the test results. Genetic counselors similar to those offered through Susan G. Komen help to encourage patients to get tested, because resources are available in the event they test positive for the BRCA gene mutations. 

In addition to the possibilities for preventative care with breast cancer, researchers are actively searching for genomic and genetic indicators of other diseases, such as diabetes. According to the American Diabetes Association (ADA), there is ample evidence that type 2 diabetes has a strong genetic component. Studies conducted by the ADA have shown that “first-degree family history is associated with a twofold increased risk of future type 2 diabetes” (Lyssenko & Laakso). Several genetic studies have shown that single nucleotide polymorphisms (SNPs) are associated with type 2 diabetes. These SNPs may provide grounds for a genetic test to determine those at high risk of developing the condition (Lyssenko & Laakso). These studies have not yet resulted in tests for clinical use, however, they show promise for the development of such tests. When tests for the diseases listed above are developed and approved for clinical use, the ways in which our healthcare system treats those diseases will change drastically. In addition to diabetes, genomic and genetic testing for cardiovascular disease, obesity, metabolic abnormalities, and epilepsy are currently in the works (“Personalized Medicine”).  In the event that genetic or genomic tests come back showing an above-average risk for developing one of the above diseases, physicians can recommend changes to lifestyle, prescribe medications, and better monitor the disease with periodic screenings. 

Personalized medicine also has the ability to increase the probability of optimal treatment outcomes with patients across the board. If you were to search the internet for success stories involving personalized medicine, you will find that they are anything but few and far between. Troy Moore shares one of these success stories in his article an article published by Drug, Discovery, and Development Magazine. Moore details the journey of a close friend diagnosed with breast cancer. Though the name of this friend remains anonymous, we learn that she decided to undergo genetic testing which revealed that she was not only resistant to the treatment she was on at the time but was also resistant to the opioid prescribed for pain relief. According to Moore, the information from the genetic testing “reshaped her treatment, her quality of life, and the way she approaches her health” (Moore). As a direct result of personalized medicine, this patient is now on the road to recovery. Patients across the United States are benefiting from personalized medicine, similar to the patient in Moore’s article. 

The benefits of personalized medicine in treatment outcomes extends far beyond cancer patients. In recent years, we have seen a large increase in the use of personalized medicine in the treatment of depression, and other mental illnesses. The current approach to treatment in the field of mental health reflects the healthcare system as a whole. Despite the fact that mental health problems differ person-to-person, the approach to treatment is “one-size-fits-all.” At the moment, patients on anti-depressants, anti-anxiety medications, mood stabilizers, and other psychotropic medications have to find the right drug and dosage through trial and error (Utley). When dealing with drugs that alter patients’ moods, these trial and error periods can be extremely dangerous. This approach often fails patients, leaving them struggling, or abandoning medications altogether. Thankfully, with the support of former President Barack Obama, research is being conducted about genes that lead to mental health conditions (Utley). Genomic or genetic testing provides patients with the hope of finding the correct medication, without the dangers of trial and error. In the field of mental health, personalized medicine leaves patients with varying health problems with the hope of improved treatment and quality of life. 

In addition to placing a focus on preventative care and increasing the probability of optimal treatment outcomes, personalized medicine allows for more informed medical decisions. In a Ted Talk given by Ian McCrae, key statistics about the U.S. healthcare system are presented. McCrae demonstrates the current lack of clinical understanding in the healthcare system. According to McCrae, when you visit a doctor in the U.S., fifty-five percent of the time the doctor does not have your complete medical history, and forty-nine percent of the time, the doctor will not be aware of what drugs you are on (YouTube). How are doctors prescribing medication and treating patients without knowing basic information such as medical history and current medications? Personalized medicine has the ability to eliminate these problems. Through the use of genomic and genetic testing, physicians will have access to a database containing the results of those tests for each patient who gets tested on hand. These results provide the physician with access to key information when making decisions about treatment and care plans for their patients. 

Those who oppose personalized medicine fear that proper regulation is not possible. Patients often worry that genetic indications of above-average risk for developing a certain disease will be used in determining insurance premiums, and eligibility. Some patients fear that the results of these tests will fall into the wrong hands, however, this is not the case. Many people are unaware of current legislation to protect patients’ genetic and genomic information. The Genetic Information Non-Discrimination Act of 2008 is a federal act that does not allow health insurance companies to use genetic or genomic information to determine insurance premiums or eligibility. This act also prevents employers from hiring or firing an individual, assigning jobs, and promoting or demoting an individual based on their genomic or genetic indicators (“Personalized Medicine”). To ensure the privacy of genetic/genomic information, the National Institutes of Health provide certificates of confidentiality to each individual to receive testing. Because the results of genomic or genetic testing are considered medical information, Health Insurance Portability and Accountability (HIPPA), protects privacy through restricting access and sharing of that information. (“Privacy in Genomics”). The Genetic Information Non-Discrimination Act and HIPPA protect patients from any misuse of genetic information. Though regulation is not easily generated, the government has taken steps to ensure the proper regulation of personalized medicine and has prioritized patient protection. 

The United States healthcare system is fatally flawed, and our healthcare system cannot remain unchanged. Our healthcare system must be reformed, or we run the risk of falling even further behind in the field of healthcare than we are now. Currently, healthcare in the United States is geared toward treating diseases, not preventing them. Healthcare costs the United States $3.4 trillion dollars annually, which equates to about twenty percent of the GNP, and $10,345 per person (Palmer). This spending is higher than any other industrialized nation, however, citizens of the United States are not healthier, our services are less affordable, and many people are uninsured or do not have access to healthcare. In 2016, 28 million people in the United States were without health insurance (Barnett & Berchick). This lack of coverage affects citizens of all ages, most of which being young adults. Unfortunately, in addition to lack of coverage, there are many health disparities among subpopulations of the U.S., such as gender, race and ethnicity, sexual orientation, and age. For example, females currently receive more healthcare spending than men, most overweight children in the U.S. are African American, and LGBT populations are less likely to get preventative services for cancer (Palmer). One of the most alarming disparities present in the United States is among college students. According to the American Psychological Association, ninety-five percent of college counseling center directors surveyed said the number of students with significant psychological problems is a growing concern in their center or on campus. A survey done by the Association for University and College Counseling Center Directors found that 41.6 percent of college students have anxiety, and 36.4 percent of college students suffer from depression. This same survey found that twenty-four percent of students were taking psychotropic medications (“College Student’s Mental Health”). With seventy-five percent of lifetime cases of mental illness beginning by age twenty-four, it is clear that mental illness has the greatest impact on college-aged students (“Mental Health by The Numbers”). As college students, these health disparities hit home. How do we not only resolve but prevent the problems we face in our healthcare system? Personalized medicine is the answer. As discussed earlier, personalized medicine shifts the focus of healthcare from treating diseases to preventing them, and provides more effective treatment for those struggling with mental illness. 

In recent years, healthcare has been a topic of discussion among government officials. An increasingly large amount of people now sees healthcare as a right, not a privilege, raising important questions about our nation’s healthcare system. Nationwide implementation of personalized medicine is the healthcare reform that our nation needs. The ability to transform and improve the current healthcare system cannot be taken lightly. In 2015, then-president Barack Obama launched the precision medicine initiative during his State of the Union Address (“The Precision Medicine Initiative”). This initiative provided $200 million in funding towards precision medicine, however, this was not enough. Though this initiative was launched close to two years ago, personalized medicine is not yet the face of healthcare in the United States. In order to shift our healthcare system, we must take action. Barack Obama once said, “change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek” (“Barack Obama’s Feb. 5 Speech”). Any person in the United States with the ability to vote has the chance to make the change that our country so badly needs. We must band together to make a difference on local, state, and national levels. Our right to vote is an extremely powerful tool, and provides the means by which people like ourselves can make a difference. We must vote for government officials that will place a priority on healthcare reform, and support personalized medicine. In addition to voting, I urge you to ask your primary care providers and other physicians about genomic testing and the use of personalized medicine in their courses of treatment. Express your interest in personalized medicine, and ask about opportunities for genomic testing. These questions will help push local healthcare facilities towards the implementation of personalized medicine. 

Personalized medicine aims to provide the right treatment, to the right patient, at the right time. Treatment is determined by studying an individual’s specific genetic makeup, and allows for the ability to target specific disease-causing genes. Personalized medicine is actually said to save on healthcare expenditures because it eliminates the trial and error of current treatment. 

Personalized medicine should be implemented on a national level, as it would result in more knowledgeable medical decisions, place a focus on preventative care, and increase the probability of optimal treatment outcomes. Neglecting to implement personalized medicine on a national level would not only negatively affect those currently suffering from health problems, but society as a whole. 
