For most of the health care consuming public (meaning all of us), the era of personalized medicine can’t get here too soon. The thought of having the mass customization of Amazon applied to our health care – using our clinical, lifestyle, and genomics data to come up a “prescription” for wellness and treatment – is very appealing.
And, personalized medicine has captured the attention of policymakers. The big investment was last year’s $215 million infusion in the Personalized Medicine Initiative (see Obama Administration Announces Key Actions To Accelerate Precision Medicine Initiative). In February, this initiative got started with a one-million-person, long-term health study to research “the interplay among genetics, lifestyle factors, and health,” setting a goal of 79,000 participants by the end of 2016, and the full one million by the end of 2019 (see NIH’s 1-Million-Volunteer Precision Medicine Study Announces First Pilot Projects and the Precision Medicine Initiative Cohort Program). But private sector funding rivals government investment. In the period between 2005-2012, $1.7 billion in private investment funding went to genomics-related initiatives (see Genomics: A Promising Investment Opportunity).
What concerns me is the mindset that personalized medicine is applicable primarily to “physical” diseases – like cancer, cardiovascular disease, and autoimmune disorders. I certainly want the benefits of the developments of personalized medicine for those disease states. But, there is new breakthrough genetic research on behavioral disorders that could remake “best practice” in treatment of mental illnesses and addictions if the field is ready to use the information.
Let’s use schizophrenia as an example. Just last week in EBioMedicine, researchers from NYU Langone Medical Center published a study that identified four genes involved in the growth or regulation of nerve circuits, and “define four previously unknown conditions within the umbrella diagnosis of schizophrenia… [revealing] distinct disease versions that may affect large slices of patients and enable precision treatment design” (for more on this story, see Four New Genetic Diseases Defined Within Schizophrenia). Another study also indicates that the clinical psychiatric symptoms that lead to a diagnosis of schizophrenia are caused by eight different types of gene cluster groups – the researchers identified 42 single-nucleotide polymorphisms (SNP) sets associated with a 70% or greater risk of schizophrenia. One SNP network associated with disorganized speech and behavior carried a 100% risk of schizophrenia (for more on this story, see Genetic Research Finds Schizophrenia Is Eight Distinct Disorders).
The new genetic findings don’t stop there. A 2013 study found that mutations in a single gene are a risk factor for schizophrenia, and a follow-up study from 2016 found that this mutation “inhibits the survival of newborn neurons in the hippocampus, leading to the psychiatric condition (for more on this story, see A Single Gene Is Linked To Several Psychiatric Diseases. A Study May Have Worked Out Why). And, a January 27 study from the Broad Institute’s Stanley Center for Psychiatric Research, Harvard Medical School, and Boston Children’s Hospital, and published in Nature, has found that a person’s risk of schizophrenia is increased if they inherit specific variants in a gene related to what researchers call “synaptic pruning”, or the elimination of connections between neurons (see Genetic Study Provides First-Ever Insight Into Biological Origin Of Schizophrenia).
The implications of these findings on what is “best practice” treatment of schizophrenia are many. But there are many impediments on the path to assuring that consumers get the “personalized medicine” that these new findings support.
First there is the “technology competency” situation. Technology is at the heart of the shift to personalized medicine. Personal health, lifestyle, and genetic information aggregated at the consumer level in a consumer-centric fashion is required for personalized medicine to be a reality. This means fully-functional electronic health recordkeeping systems, consumer-directed consumer portals for individual data aggregation, and standardized health information exchange capabilities (for more, see Healthcare Gets Personal). “Big data” and analytics are at the core of making personalized medicine available on a broad scale – but that is not possible without a solid tech foundation at the provider and consumer level.
Second, changes will be needed in our treatment approaches and health benefit policies. Again, using schizophrenia as an example, if we now know that there are many “varieties” of schizophrenia (maybe four or eight), health care professionals need to help each consumer identify the “type” of schizophrenia that they have and the treatment protocol that has the highest likelihood of success for their condition. This will require a change in diagnostic protocols and decision support tools to match consumers with treatment. This will also require an end to the current health benefit plan policies regarding medication and other treatment interventions. Current protocols for payment of many types of treatment are based on the assumption that those treatments are interchangeable. The new genetic research shows that this is not the case. (For more, see How Many Health Plans Have “Fail First” Policies For Mental Health Prescriptions? and It’s Fail First Again.)
The possibilities for personalized medicine, informed by more genetic research, will continue to grow – and the implications for better treatment of mental illnesses and addictive disorders are many. But, I think executives in the field need to be proactive in thinking about how to speed the 17-year time period that it takes for scientific discoveries to make their way to consumers in the field. This is possible, but not probable, without some concerted planning (see The Snags In ‘Speed To Market’ For Health Care Innovations).
For even more on the developing initiatives in the personal medicine space, check out these resources in the OPEN MINDS Industry Library:
- More Genetic Testing Information Means?
- Priorities for Personalized Medicine
- Personalized Medicine – Ready Or Not?
- The End Of Symptomatic Psychiatry?
- Medicine In Denial
What does the future of this technology look like? We won’t be able to answer that for some time yet – we’ll be sure to keep you updated. If you don’t know where we’re going with these bleeding edge innovations, how do you prepare? For more on recognizing and adopting innovative practices, join me for my plenary address, “Is Your Organization Innovation-Ready? How To Transform Innovation Into Strategic Advantage,” on June 9 at The OPEN MINDS Strategy & Innovation Institute.