Doctors have always recognized that every patient is unique, and doctors have always tried to tailor their treatments as best they can to individuals. You can match a blood transfusion to a blood type—that was an important discovery. What if matching a cancer cure to our genetic code was just as easy, just as standard? What if figuring out the right dose of medicine was as simple as taking our temperature?—Former President Obama, January 30, 2015, State of the Union Address
What former President Barack Obama is describing is precision medicine. With the launch of the Precision Medicine Initiative in 2015, he helped bring to people of the United States a new concept of health care that is tailored to the individual.
Precision medicine means that doctors will use patients’ medical histories, genetic information and relevant research to create a treatment plan designed for them. It will give doctors the tools they need to best care for and treat their patients, says Mylynda B. Massart, MD, PhD, assistant professor of family medicine at the University of Pittsburgh. She is also medical director at UPMC Matilda H. Theiss Health Center.
“If doctors know what diseases patients are at risk for through genetic testing, we might be able to treat them in a way that would help prevent those diseases,” says Dr. Massart. “For example, people are at risk for cancer because they’re smokers. From research, I know that smokers have a certain chance of getting lung cancer. But with precision medicine, I might be able to tell patients that, based on their genetic information and family history, whether they will get a disease like cancer. Having that data will allow health care providers to talk specifically about their patients’ health.”
Health care is based on research. Medications are developed through research, under rigorous review and with people agreeing to participate in research studies. But, in the past, research did not always include people from all racial and ethnic backgrounds. Also, historically, people from certain racial and ethnic backgrounds have been reluctant to participate in research. Therefore, research has been done on limited patient populations.
“For example, a lot of research on cholesterol medication has been done on middle-aged white men,” says Dr. Massart. “We wouldn’t know if that medication would have the same effect on, say, African American women or Latino men. So, we can’t always base health care practices on the research that has been done.”
Precision medicine involves getting as much data as possible, from as diverse a patient population as possible. It allows doctors to put research in context with a patient’s personal information and create a treatment specific to that person. Health care providers like Dr. Massart consider this a step forward in the practice of medicine.
Precision medicine also has the potential to positively affect the use of medications. Research is revealing more about how people’s genetic makeup affects their response to certain medications (the field of pharmacogenomics). With this information and all the data about personal history, doctors can know right away which medicine will work best for an individual instead of going through the sometimes-long process of trying a medication, waiting to see if it works, moving on to the next medication, waiting to see if it works and so on.
Because precision medicine involves the use of personal information, people sometimes have privacy concerns. Dr. Massart notes the Genetic Information Nondiscrimination Act (GINA) of 2008. It prohibits the use of genetic information in health insurance and employment. GINA provides some protection.
People from Southwestern Pennsylvania have an opportunity to contribute to the precision medicine momentum. Former president Obama, recognizing that we needed a much broader and diverse research database, created the All of Us research program through the National Institutes of Health. PA Cares for Us is the local arm of the national program. The University of Pittsburgh was awarded a grant to recruit participants over the next five years. The goal is to recruit a truly diverse population—diverse in terms of geography, age, ethnicity, race, sexual orientation, gender identification, etc.—from Western Pennsylvania. Participants will join a research network where they will provide access to their electronic health records, personal history, and bio samples (urine and blood for genetic testing, weight, height, blood pressure, etc.). Participants will have opportunities over many years to provide data about themselves that will help researchers learn more about how individual differences in lifestyle, environment and biological make-up (such as genetic background) influence health and disease. This is expected to lead to new treatments tailored to individual patients.
Precision medicine is starting to be a part of people’s health care. Dr. Massart says, “We’re using genetic information to know patients’ risk for having certain diseases and how to treat them (like testing a patient for a BRCA gene mutation, which can indicate a higher risk for cancer, if that patient has a consistent family history of breast or ovarian cancers). We don’t have global genomic information being integrated into many health systems yet, but some are starting that process.”
Learn More about Precision Medicine
Are you interested in precision medicine and want to learn more? Check out the following websites:
PA Cares for Us Research Program explains the local precision medicine initiative and how participants can help create a healthier future:
https://pacaresforusresearch.org/.
Precision medicine experts have partnered with WebMD to provide an overview of the topic at www.webmd.com/cancer/precision-medicine#1.
Precision Medicine Initiative page in the White House archives, which includes testimonials and stories about how this new area of research has helped individuals as they battle serious diseases and cancer:
obamawhitehouse.archives.gov/node/333101.
Questions about precision medicine can be e-mailed to partners@hs.pitt.edu.
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