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The promise and challenge of personalized medicine: aging populations, complex diseases, and unmet medical need.

Henney AM - Croat. Med. J. (2012)

Bottom Line: It is also being seen as one approach that may have a beneficial impact on reducing health care budgets.But what are the challenges that need to be addressed in its implementation in the clinic?This article poses some provocative questions and suggests some things that need to be considered.

View Article: PubMed Central - PubMed

Affiliation: Obsidian Biomedical Consulting Ltd., Macclesfield, UK. adriano.henney@virtual-liver.de

ABSTRACT
The concept of personalized medicine is not new. It is being discussed with increasing interest in the medical, scientific, and general media because of the availability of advanced scientific and computational technologies, and the promise of the potential to improve the targeting and delivery of novel medicines. It is also being seen as one approach that may have a beneficial impact on reducing health care budgets. But what are the challenges that need to be addressed in its implementation in the clinic? This article poses some provocative questions and suggests some things that need to be considered.

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Related in: MedlinePlus

Disability (light gray) and mortality (dark gray) contribution to the total disease burden for selected diseases in Europe (WHO subregion EUR A). Source: Kobelt G, Kasteng F. Access to innovative treatments in rheumatoid arthritis in Europe, reproduced with permission from The Pharmaceutical Industry in Figures, EFPIA, 2010 edition (2).
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Figure 1: Disability (light gray) and mortality (dark gray) contribution to the total disease burden for selected diseases in Europe (WHO subregion EUR A). Source: Kobelt G, Kasteng F. Access to innovative treatments in rheumatoid arthritis in Europe, reproduced with permission from The Pharmaceutical Industry in Figures, EFPIA, 2010 edition (2).

Mentions: And how is this to be achieved? It is interesting to note that many, if not all of the examples cited when discussing personalized medicine strategies, refer to studies in cancer. In the late 1990s, approvals of Gleevec and Herceptin raised hopes for a more rational targeted and personalized approach to therapy. More recently, innovative medicines targeting mutations in bRaf and anaplastic lymphoma kinase have been launched together with companion diagnostics. It is clear that the strong genetic drivers of disease progression in cancer provide an excellent platform to test and exemplify many of the technologies that might be applied routinely in personalization strategies for other diseases. But I would argue that these are very specialized cases because of the strong underlying genetic influences: if they are not themselves examples of diseases arising from major single gene defects, where mutation analysis has become part of routine clinical practice, neither are they the same as complex multifactorial diseases, where the interaction of a range of genes of small effect and environmental factors contribute to the emerging phenotype. While cancers are undoubtedly major causes of morbidity and mortality, and are diseases that raise many emotive debates on the relative costs and benefits of treatment in the context of quality of life, it is arguable that they are not the diseases that pose the greatest burden on health care budgets (Figure 1). The combined cost of inpatient and outpatient treatment, care, and loss of economic productivity in chronic, debilitating diseases such as circulatory and respiratory disease, dementia, diabetes and arthritis imposes a major drain on health care budgets. These complex multifactorial diseases are arguably more important to address in the context of personalization strategies if benefit to the greater proportion of populations and the consequent impact on reducing health care costs is to be achieved.


The promise and challenge of personalized medicine: aging populations, complex diseases, and unmet medical need.

Henney AM - Croat. Med. J. (2012)

Disability (light gray) and mortality (dark gray) contribution to the total disease burden for selected diseases in Europe (WHO subregion EUR A). Source: Kobelt G, Kasteng F. Access to innovative treatments in rheumatoid arthritis in Europe, reproduced with permission from The Pharmaceutical Industry in Figures, EFPIA, 2010 edition (2).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3368289&req=5

Figure 1: Disability (light gray) and mortality (dark gray) contribution to the total disease burden for selected diseases in Europe (WHO subregion EUR A). Source: Kobelt G, Kasteng F. Access to innovative treatments in rheumatoid arthritis in Europe, reproduced with permission from The Pharmaceutical Industry in Figures, EFPIA, 2010 edition (2).
Mentions: And how is this to be achieved? It is interesting to note that many, if not all of the examples cited when discussing personalized medicine strategies, refer to studies in cancer. In the late 1990s, approvals of Gleevec and Herceptin raised hopes for a more rational targeted and personalized approach to therapy. More recently, innovative medicines targeting mutations in bRaf and anaplastic lymphoma kinase have been launched together with companion diagnostics. It is clear that the strong genetic drivers of disease progression in cancer provide an excellent platform to test and exemplify many of the technologies that might be applied routinely in personalization strategies for other diseases. But I would argue that these are very specialized cases because of the strong underlying genetic influences: if they are not themselves examples of diseases arising from major single gene defects, where mutation analysis has become part of routine clinical practice, neither are they the same as complex multifactorial diseases, where the interaction of a range of genes of small effect and environmental factors contribute to the emerging phenotype. While cancers are undoubtedly major causes of morbidity and mortality, and are diseases that raise many emotive debates on the relative costs and benefits of treatment in the context of quality of life, it is arguable that they are not the diseases that pose the greatest burden on health care budgets (Figure 1). The combined cost of inpatient and outpatient treatment, care, and loss of economic productivity in chronic, debilitating diseases such as circulatory and respiratory disease, dementia, diabetes and arthritis imposes a major drain on health care budgets. These complex multifactorial diseases are arguably more important to address in the context of personalization strategies if benefit to the greater proportion of populations and the consequent impact on reducing health care costs is to be achieved.

Bottom Line: It is also being seen as one approach that may have a beneficial impact on reducing health care budgets.But what are the challenges that need to be addressed in its implementation in the clinic?This article poses some provocative questions and suggests some things that need to be considered.

View Article: PubMed Central - PubMed

Affiliation: Obsidian Biomedical Consulting Ltd., Macclesfield, UK. adriano.henney@virtual-liver.de

ABSTRACT
The concept of personalized medicine is not new. It is being discussed with increasing interest in the medical, scientific, and general media because of the availability of advanced scientific and computational technologies, and the promise of the potential to improve the targeting and delivery of novel medicines. It is also being seen as one approach that may have a beneficial impact on reducing health care budgets. But what are the challenges that need to be addressed in its implementation in the clinic? This article poses some provocative questions and suggests some things that need to be considered.

Show MeSH
Related in: MedlinePlus