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The history of medicine contains several major milestones; from germ theory to vaccines to the discovery of antibiotics. Each of these discoveries has had a significant impact on medical practice, with childhood vaccinations now considered the norm, antibiotics being administered without a second thought, and the concept of microorganisms being the causative agents of diseases now seen as common knowledge. It is my belief that the next significant milestone along the road of medical progress will be the implementation of personalised medicine. It is likely that there will come a time in the near future when it will become the new norm to have a disease diagnosed within a matter of hours, or onset of a disease predicted early in life and preventative measures taken before it can take hold. This is the basis of personalised medicine, and these are the three key ideas that it encompasses:
Prediction:routine monitoring of a persons’ health in order to predict which illnesses they are at risk of developing.
Prevention:use of this information to take preventative measures to reduce development of preventable illnesses.
Personalisation:if illness does arise, making disease treatments for each patient specific.
Prediction of which illnesses people are likely to develop will depend on a system of monitoring a persons’ health over time, and finding out what they are susceptible to. This will be achieved by looking at both a person’s genes and lifestyle, both of which can contribute to development of disease. For instance, the ability to sequence the human genome has developed greatly since the Human Genome Project. Everyone can now have their whole genome sequenced through projects such as ’23andMe’ in order to find out if they are genetically predisposed to suffer from conditions such as heart disease in later life . The Institute of Systems Biology is also working towards a project called ‘P4 medicine’, which would monitor the proteins in a persons’ blood throughout their lifetime, so that early onset disease in any organ of the body can be quickly and accurately detected .
Information such as this can then be used to take preventative measures to reduce the risk of a person developing a disease. We all currently take small preventative measures in our daily lives to reduce the risk of developing disease, such as washing our hands, brushing our teeth,regular exercise and cutting down on alcohol intake, for example. Personalised medicine could take this further. By predicting future health conditions which may develop, people will be directed towards more specific changes to their lifestyle, and towards specific preventative measures where life-threatening disease is implicated. For instance, genetic screens for people at risk of breast cancer are now available on the NHS, and thus personalised prediction and prevention of disease is already a reality in this instance.
Personalisation of disease treatment will perhaps be more relevant when a health issue has already arisen, as in the area of infectious disease. In this area particularly, personalisation of treatment will be essential in ensuring that patients receive the most appropriate, effective treatment as early as possible upon development of disease. This will be achieved again through genome sequencing, but this time with a focus on sequencing the genome of the infecting microorganism. The aim of this will be to find out the severity of the developing disease, any potential complications which may arise throughout the course of the disease and, in the case of bacterial infections, finding out its antibiotic resistance profile. This will enable the most appropriate and effective drugs to be administered as early as possible.
However, while this may all sound simple in principle, there is much to be done to reach these goals, and many challenges will undoubtedly be faced along the way. Routine monitoring of a persons’ health throughout their lifetime will be a costly system to introduce, and it is entirely possible that many people would object to a system which could reveal information about their long term health that they simply do not want to know, particularly regarding genetic predispositions to conditions such as heart disease that are difficult to prevent. At the other end of the spectrum are the hypochondriacs, or otherwise known as the ‘worried well’ who will be paying too close attention to their data, waiting for illness to befall them.
A further issue which will need to be addressed is that of data storage. If a persons’ health is to be monitored and the data recorded throughout their lifetime, where will all this data be stored? Who will have access to it? How will it be kept private? These issues will need serious consideration before this kind of system can be introduced.
While health monitoring and prediction of disease development throws up certain ethical issues, personalisation of disease treatment will be more of a technical challenge. Current disease diagnostic techniques are often time consuming and costly. They are usually based on an assessment of the symptoms observed in a patient, in combination with laboratory diagnostic techniques such as analysis of blood samples and culturing of bacterial samples from swabs, depending of course on the type of disease. These techniques can often take anything from a few days to several weeks to produce a result, in which time an inappropriate treatment may already have been prescribed.
In cases of bacterial infection for example, medical practice is usually to prescribe broad-spectrum antibiotics (which target a wide range of disease-causing bacteria) based on clinical symptoms, with more specific treatment administered at a later stage when the infecting bacterium has been identified. In some cases this can be detrimental to a patient’s health; for instance if the disease is caused by an antibiotic-resistant strain, as is becoming increasingly common, prescription of broad-spectrum antibiotics may prove no use at all in treating the disease, and if anything serves to further the spread of antibiotic resistance while the patient’s health worsens.
Thus, the problem will be development of a quick and accurate technology, which is able to sequence the genome of an infecting microorganism in a matter of hours. Some companies are already making progress on this front. For instance, one company has recently announced the development of technology to diagnose chlamydia infections in the space of thirty minutes, as opposed to the current waiting time of two weeks . Not only will this kind of technology improve the time taken to administer treatment, in the future it will ensure that only the most appropriate treatments are given, meaning that our remaining effective antibiotics can be saved only for when they are most needed. Therefore, each patient will be given the treatment that is best for them instead of the treatment that works the best ‘on average’.
These are the challenges that will face personalised medicine in the future, some more difficult to overcome than others. However, it is highly likely that this kind of system will soon become a reality, with a significant amount of medical research focusing in this area. Some aspects of personalised medicine will be a major improvement, particularly in improved treatment of infectious disease. However, some aspects will be highly controversial and will perhaps take longer to come to fruition.
Ultimately the benefits of all this will be in giving people the choice to take action to improve their health. With obesity, alcoholism, smoking and many other issues currently taking a huge toll on medical services in the UK, it may not be such a bad idea to guide people towards a healthier lifestyle. Importantly, with a looming crisis in antibiotic resistance, it will undoubtedly be a good idea to improve how we approach infectious disease treatment. In the end, I believe that personalised medicine, in whatever form we choose to take advantage of it, will be the next major milestone along the road of medical progress.