From sci-fi movies to dystopian novels, the idea of personalized medicine had been a dream for the future; however, with the increased attention towards immunology and genetics over the years, people have come to realize the importance of tailoring medicine to fit the individual. It has long been recognized that some people respond better than others to prescribed drugs, and thus more recently, there has been a shift towards personalizing drugs for the individual to achieve maximum effectiveness. Many disease fields such as autoimmune diseases, allergy, cancer, and genetic counseling have seen an effort in pushing towards customized therapies.
Personalized medicine often relies on genetic screening of the patient to tease out potential targets. Genetic screens are powerful tools that can allow us to uncover the risk of someone acquiring a certain type of disease, and of the few genetic tests that have been widely commercialized, most have been put into good use with considerable results. Myriad’s BRCA1/ BRCA2 test, for example, has been used to test the risk for ovarian and breast cancer and has saved numerous lives by enabling preventative measures before the onset of disease. Furthermore, genotyping can reveal how patients may react to a certain type of treatment and how much of the treatment is needed to get a therapeutically relevant response. Information on a patient’s genes can also help identify the dosage at which the medication should be prescribed and those who will react adversely to medication and prevent future complications. Personalizing medicine using genetic screening can improve the quality of treatment patients receive by assisting decision-making regarding the best treatment for each individual.
In the realm of cancer, genetic screening offers better drug effectiveness and dosage control to maximize the positive effects and minimize damage to non-cancerous cells. Cancer is one of the fields that has seen the most advances in immunology in recent years as immunotherapy has been a step up from traditional chemotherapy in its ability to reduce damage and cell death. Recent advances have been creating personalized treatments for the individual patient, with some even using the patient’s own cells as the basis for treatment. One example is CAR-T cell therapy, which is one of the newest and most effective personalized cancer treatments in recent years. This involves harvesting T cells from the patient, loading chimeric antigen receptors (CARs) onto the surface of the T cells, then infusing the engineered T cells back into the body. These chimeric T cells antigen receptors are able to recognize and attack cancer cells directly without needing help from other immune cells, which creates a system that is much more specific and direct than traditional cancer treatments. CAR-T cell therapy is still a novel treatment that has yet to become widely available, but clinical results have shown that it is a promising cancer therapy in which many patients find success.
Although the initial cost of tailored treatments is higher, a more effective treatment could mean needing fewer additional treatments or switching of treatments.
One of the most important and practical questions that must be asked about any drug or treatment is its accessibility and affordability. Just how affordable is personalized medicine compared to traditional treatments? Unfortunately, the harsh reality is that the costs of personalized medicine are much higher. Since the treatment becomes highly tailored towards the individual, this means that the treatment invariably becomes more unique and unable to be mass-produced, increasing production costs and financial burden to the user. Some novel treatments could have prices as high as $373,000 for one CAR-T infusion, which is clearly not an accessible option for the majority of people. However, there are some caveats to this statement. Although the initial cost of tailored treatments is higher, a more effective treatment could mean needing fewer additional treatments or switching of treatments. As novel methods develop, there is also no doubt that more emphasis in the near future would be put on making treatments more available as well as affordable. Having more affordable personalized medicine would outshine the many traditional therapies people resort to currently.
While the financial aspect of personalized medicine is one concern, genetic screening also brings many other questions. For one, where does this information go? How is it stored? And how is it being used? Although the patient’s consent is always required when obtaining information such as one’s genes, some people are more hesitant on the idea of giving others access to something that could breach their sense of privacy. Often, when someone signs up for genetic testing, consent for their genetic information to be used in research is a default selection. There has been much controversy regarding the “compulsory choice” to share their private information. On one hand, patients should not have to make the choice to sacrifice their privacy in exchange for better medical care. On the other hand, genetic information from cases is crucial for further advances in treatment development. While the benefits of genetic screens are blatant in improving the diagnosis and treatment of patients, controversy still surrounds the use of these techniques to advance scientific approaches, especially when concerning patient privacy.
Another concern of personalized medicine involves genetic counseling. Genetic counseling has become an increasingly popular method to help determine a couple’s chances of conceiving a child with a certain hereditary disorder or birth defect. It has been able to help many families make the best decision for their future. However, a common concern underwritten in genetic counseling is how does it affect decision-making about having a child? Does knowing potential outcomes prevent couples from having children? And is it irresponsible to make the decision to have a child despite knowing the chances of a disorder are high? There are many ethical questions that shake the integrity of personalized treatments and these have yet to be answered.
Personalized medicine is still a novelty in terms of development, but with the speed at which research has been advancing, there is no question that there will be treatments with higher precision and greater access for the public. Although their use is still controversial according to some, the positive results and the underlying potential of individualized treatments are undeniable. With the continuation of the current trend of research and an effort to address potential shortcomings, personalized medicine will become the new gold standard of treatment for many diseases.
Melissa Liu
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