Gene Medicine - it doesn't get more personal

 

Soon every health decision taken, or medicine given will be entirely predicated by the nature of the DNA in your genes. For many breast cancer patients, this genetic approach is already routine. Afterall, why should any cancer patient have to face the prospect of chemotherapy if their genes say they will not respond to this this form of treatment anyway? This form of gene-determined medicine is called 'Precision Medicine', and globally governments are investing heavily in screening millions of people in order to obtain sufficient data on the different gene clusters - and how these actually relate to disease and pathology in the doctor's clinic.

 

As the UK's Clinical Genetics expert, Dr James Mackay says, "Genetic testing is the future of diagnostic-led medicine as it enables therapeutic approaches to be entirely personalised to the clinical requirements of the patient." This has also coined the phrase P4 Medicine, the 'P's' standing for; predictive, preventive, personalised and participatory.

 

So, why isn't every patient offered 'precision' or P4 medicine now? There are a number of reasons for this, but chief among them is the need to establish what exactly the meaning of every gene cluster variation is, as well as understanding the implications of these variations in real, clinical terms. The only way to establish some meaning is to study similar genes in (ideally) millions of people and correlate the data to their clinical health or disease status.

 

The scale of this task cannot be underestimated, but many countries, backed by huge investment from their governments have already made a good start. For example:

 

UK Genes

 

Thanks to the NHS, the UK has direct access to millions of patients and this prompted Genomics England to undertake the 100,000 Genomes Project. This project states the likely outcome to be that, "Patients may be offered a diagnosis where there wasn't one before ... there is the potential of new and more effective treatments'.

 

USA Genes

 

In the US the Precission Medicine Initiative was officially launched a year ago. In his State of the Union address, President O'Bama said, "I want the country that eliminated polio and mapped the human genome to lead a new era of medicine —  one that delivers the right treatment at the right time".

 

China Genes

 

However, possibly the biggest genome assessment undertaking is now happening in China. As reported in the journal Nature, "China embraces precision medicine on a massive scale". The news report states that, "leading institutes including Tsinghua University, Fudan University and the Chinese Academy of Medical Sciences are scrambling to set up precision-medicine centres. Sichuan University’s West China Hospital, for instance, plans to sequence 1 million human genomes itself the same goal as the entire US initiative. The hospital will focus on ten diseases, starting with lung cancer."

 

So, precision medicine is set to revolutionise global healthcare, and no doubt soon we shall all carry our own digital DNA medical passports (DMPs). However, as is currently being stated in China, it is one thing to know your own DNA variations, but doctors are now going to have to learn fast how to be able to use this data for the benefit of their patients - and this will be an entirely separate challenge. At present there is only one Accredited Clinical Geneticist in the UK (Dr James Mackay), although this situation is likely to change rapidly.