The Challenges of Personalised Medicine

The healthcare industry has traditionally offered the same treatments and medications for an illness or disease regardless of an individual’s genetics. In the last few years technology in the sector has developed to the point that instead personalized treatments are now possible. Personalized medicine uses genetics to understand a person’s medical problems and to be able to determine specific treatment and prevention plans for the individual. The global personalized medicine market size was estimated at $1.57 trillion in 2018 and is forecasted to continue growing with a CAGR of 10.6% during 2019-2025.

This approach offers many benefits to both patients and the medical profession. When it comes to treatment options, the most effective drugs or treatment plans can be prescribed, and genetic variations can guide drug dosage minimizing unnecessary side effects. This also avoids the costs of unwarranted and ineffective treatments. For example, DNA sequencing is already being used in the treatment of chronic myeloid leukaemia for those whose standard treatment doesn’t work, to distinguish whether they need drug therapy or a bone marrow transplant. For many diseases, having the most effective treatment as quickly as possible is likely to have a positive impact on the prognosis for the patient.

As well as the positive impacts on the treatment of disease by utilizing personalized medicine, prevention of future diseases can be achieved through using sequencing technologies. By identifying the illness a person is genetically prone to developing, the individual may be able to adopt lifestyle changes and take preventative measures to avoid becoming ill. For example, some types of cancer can be strongly influenced by genes. A recent study showed women who have a BRCA1 mutation have a 72% chance of developing breast cancer by the age of 80, and those with a BRCA2 mutation have a 69% chance. Detecting these variants allows individuals to have enhanced screening or risk-reducing surgery.

However, many ethical, legal and social challenges have been raised against personalized medicine. Currently, there is no regulatory framework for personalized medicine and the current medical and research regulations cannot be applied. An important issue is the privacy rights of the individual versus the rights of related family members, which is something that also needs to be considered. If an individual discovers they have a disease that is inheritable, should family members have the right to be informed that they too might be at risk? Some would argue this would invade the individual’s right to privacy, but if the illness is one that could be prevented or one that requires early diagnosis and treatment, should those rights overrule?

It could also be argued that highlighting someone is genetically more likely to get a life-altering or terminal disease could cause mental distress, which may be deemed unethical. To mitigate the potential impact, should patients have compulsory counselling before and after genetic testing and if so, how would this work in practice as its popularity grows? Also, should an individual’s mental health be taken into consideration prior to offering testing or is it discriminatory to restrict a patient’s access to something that could have implications on their future health? Further distress could be caused to patients regarding their eligibility for health insurance policies. Insurance companies could, in theory, refuse to insure those with certain genetic predispositions causing more stress to an individual regarding their future health. However, particularly in the US, legislation is in place to help prevent this from happening. The Genetic Information Non-discrimination Act (GINA), makes it illegal for health insurers in America to factor genetic information into decisions about insurance eligibility or premiums.

Many of the issues raised involve weighing up an individual’s rights versus the responsibility a health care system has to those individuals to avoid mental harm for themselves and their families. I feel that personalized medicine has a promising future, and I am excited by the forecasted growth of the sector, but there are key issues that need to be resolved to help the industry experience more growth. If you are operating in this industry, I would like to hear your thoughts on the challenges you are facing and how you feel they can be best overcome. Contact me at vicky.kerrigan@csgtalent.com.

References

News Medical Life Sciences, Is Personalized Medicine the Future of Healthcare

Grand View Research, Personalized Medicine Market Size, Share & Trends Analysis By Product (Personalized Medical Care, Therapeutics, Personalized Nutrition & Wellness), By Region (Asia Pacific, Europe, North America), And Segment Forecasts, 2019 - 2025

National Cancer Institute, BRCA Mutations: Cancer Risk and Genetic Testing

NCBI, Perspective: Balancing Personalized Medicine and Personalized Care

The Scientist, Protecting Patients from Genetic Discrimination