Dr. Geoffrey Ginsburg is executive director of the Duke Center for Personalized Medicine. Here, he explains how recent technological advances are making it possible to customize health care.
Q: What is personalized medicine?
Personalized medicine has been a goal since the beginning of medicine. What is unique about the time we are living in now is both the ability to generate data about disease and use that data to refine and truly individualize our evaluation and treatment. Personalized medicine does not mean that we will have a unique drug for each of us for a given disease. But it does reflect our ability to align medical care to the values, beliefs, environment and genetics of an individual.
Q: How is personalized medicine being used in clinical care today?
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When a doctor asks a patient about his or her smoking history, measures cholesterol levels, determines that the risk for heart disease is much higher than average and recommends diet, exercise and a drug – that’s personalized medicine. The area where personalized care has proliferated most is probably in the treatment of cancer. Because cancer is a genetic disease, changes in the DNA of cancer cells are what primarily drive the cells to become cancerous. We now have a pretty comprehensive idea of the genetic changes in both solid tumors like breast, lung, and ovarian and prostate cancer as well as in leukemias and lymphomas.
In the past year a number of novel cancer drugs have been developed and approved by the FDA to “target” these genetic alterations in the cell, expanding the targeted ammunition against cancer that include herceptin (breast cancer), cetuximab (colorectal cancer) and dozens of others. It is estimated that there are over 400 new “targeted therapies” currently in the development pipelines of drug companies today.
So it is likely we will see many more examples in the coming years, not only in cancer but in other chronic diseases such as cardiovascular disease, rheumatoid arthritis and neurologic disease.
Q: What are some of the ethical issues that researchers need to consider as care becomes more personalized?
The one characteristic of the genomic information underpinning much of personalized medicine that may set it aside from other types of medical information is its predictive nature – the ability to forecast the probability of a future medical event. For this reason ethicists have gotten involved in helping us understand the societal issues of privacy and confidentiality. They are also asking whether and how to disclose information about future disease risks to people who are healthy, and encouraging debate and discussion about results of genetic testing for which there are no cures.