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 right now, 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 revolves 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 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. Some fear that the name “personalized medicine” is dangerously misleading. Many in opposition with this paradigm shift argue that truly personalized medicine is not possible, and mislabeling medicine may lead to false hope. Others feel that the national implementation of personalized medicine would result in ethical consequences much larger than we can imagine. Some 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. Those who feel treatments should be tailored to the individual, often forget to acknowledge the cost of developing individualized drugs. People also worry that any genomic information that indicates a certain disease will be misused by insurance companies, driving monthly premiums through the roof. Some 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 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 the field of personalized medicine. 

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, and these changes in treatment did not stop with cancer. Genetic information was also used to identify the best depression drugs 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 40 private-sector organizations have committed to implementing precision medicine in accordance with the key principles of the initiative (“Fact Sheet”). 

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.). Genomic and genetic testing allows for screenings that provide insight on susceptibility to a variety of diseases. 

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 for developing these cancers. Up to 10% of breast cancers in the United States are linked to an inherited gene mutation, most of which being 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, if one falls under the criteria listed above. 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”).  

In addition to the possibilities for preventative care with breast cancer, researchers are actively searching for genomic and genetic indicators of other diseases. Genomic and genetic testing for cardiovascular disease, diabetes, obesity, metabolic abnormalities, and epilepsy are currently in the works (“Personalized Medicine”). In the event that these 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. The genetic testing lead to a change in the course of her treatment, and greatly improved her quality of life. This patient is now on the road to recovery as a result of personalized medicine (Moore). 

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 health care 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 antidepressants, 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). Personalized medicine leaves patients with varying health problems with hope of improved treatment. 

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 provides statistics that demonstrate the current lack of clinical understanding in the healthcare system. According to McCrae, when you visit a doctor in the U.S., 55% of the time the doctor does not have your complete medical history, and 49% 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 key information when having to make decisions about the treatment and care plans for their patients. 

Those who oppose personalized medicine fear that proper regulation is not possible. Some worry that genetic indications of above-average risk for developing a certain disease will be used in determining insurance premiums, and eligibility. Others fear that the results of these tests will fall in 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”). Though regulation is not easily generated, the government has taken steps to ensure the proper regulation of personalized medicine.

The United States healthcare system is fatally flawed, and as a country, we cannot

continue down the path that we are on. 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. Healthcare in the United States is geared toward treatment and not prevention. Healthcare costs the United States $3.4 trillion dollars annually, which equates to about 20 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 the 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 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 24.5 percent of students were taking psychotropic medications (“College Student’s Mental Health”). With 75 percent of lifetime cases of mental illness beginning by age 24, 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 2 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.” 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 with health problems, but society as a whole. 
