Genes May Help to Personalize Health Care

Harold Mandel's picture
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The age of personalized medicine or personalized health care may already be upon us.

There have been heated emotions about what in many instances appears to be a depersonalization of health care in this era. Fears about such a dehumanization in the provision of health care are often automatically linked to concepts of using genetic therapy for health care. However, paradoxically the scientifically intricate concept genetic therapy can be used to personalize health care in dramatic ways.

Everyone has a unique genetic makeup

Each individual has a unique genetic makeup, making you one of a kind, as shared in a report on personalized medicine using your genes by the National Institutes of Health. Because of individual variations in our genes, we all have unique personalities with different facial features and other body characteristics. These individual genes also play a role in determining your risk for different diseases and your response to various medications. An understanding of these genetic realities makes it an antiquated concept to consider that all medicines will work the same for everyone. Some medicines that work well for some people do not work well at all for others, and may even cause serious problems.

By using a consideration of your individual genetic characteristics it becomes possible to design both treatments and preventive care which are just right for you. The careful matching of your individual biology to your medical care is known as an aspect of personalized medicine. This approach is being used by innovative health care providers at this time. An accurate consideration of personalized medicine begins with the unique set of genes you have inherited from your parents, with the same genes generally differing slightly between people.

Pharmacogenomics is the study of how genes affect the way medicines work in your body. Dr Rochelle Long, a pharmacogenomics expert at NIH, has said, “If doctors know your genes, they can predict drug response and incorporate this information into the medical decisions they make.” It has been more common in recent years for doctors to test for gene variants before prescribing some drugs. Consider that some HIV-infected patients are severely allergic to some of the treatment drugs, and now there are genetic tests which can help identify who can safely take the medicines. Long says, “By screening to know who shouldn’t get certain drugs, we can prevent life-threatening side effects.”

Aggressive forms of cancer treatment are also making use of pharmacogenomics. It has been found that there are some breast cancer drugs which only work in women with particular genetic variations. Also, even a drug which is as common as aspirin may have varying effects based on your genes. There are millions of people taking aspirin daily to reduce their risk for heart attack and stroke. Aspirin works by preventing blood clots which have the potential to clog arteries. However, aspirin doesn’t lower heart disease risk in everyone. A set of genes with unique activity patterns which can help determine whether someone will benefit from taking aspirin for heart health has recently been identified by NIH-funded researchers.

The NIH has also funded research to study a different clot-fighting drug which is known as clopidogrel (Plavix). This drug is often prescribed for people who are at risk for heart attack or stroke. Dr Alan Shuldiner at the University of Maryland School of Medicine, and his associates, examined people in an Amish community. They chose an Amish community because such an isolated community has less genetic diversity than the general population. This made it easier to study the effects of genes on this drug. It was found that many of the Amish people had a particular gene variant which made them less responsive to clopidogrel. Further research showed that about one-third of the general population may have similar variations of this gene, which means they too probably need a different medicine to help them lower heart disease risks.

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It's easy to get a genetic test

It isn't very difficult to get a genetic test. Doctors generally take a sample of body fluid or tissue, such as blood, saliva or skin, which is sent to a lab. However, the decision about whether or not to get a particular genetic test may be difficult. There are genetic tests which are now available for approximately 2,500 diseases, with more tests being worked on. Your physician may suggest that you get tested for specific genetic diseases if they run in your family or if you have certain symptoms of a disease. Dr. Lawrence Brody, a genetic testing expert at NIH, has said, “While there are many genetic tests, they vary as to how well they predict risk.”

Your genome may someday become part of your medical records

A new trend in personalized medicine has been to get your whole genome sequenced. Although this is still expensive, the cost has gone down dramatically over last past decade and is likely to continue to fall. Because your genome essentially remains the same over time, this information could someday become part of your medical record, which doctors could consult as needed. A family history is a good place to begin with determining genetic risk factors.

However, there is more to personalized medicine than this. Your current state of health and lifestyle help determine your risk for diseases. Clearly, smoking, a poor diet, and a lack of exercise can increase your risks for very serious health problems, such as heart disease and cancer. There are steps which can be taken to lower your unique health risks, which can be discussed with your doctor. Genes and the environment combined cause disease, as reported on by EmaxHealth reporter Kathleen Blanchard, RN.

Personalized medicine offers great promise

The great promise which personalized medicine has to offer is discussed in a report by Vanderbilt University. The trend towards personalized medicine has made the family doctor well liked by many people again, just as was true at earlier times. In fact an entire team of health care providers, including the family nurse, and the family pharmacist, and a whole team of family health care providers, is utilizing 21st-century tools such as genomics, informatics and high-tech imaging to help improve the quality of health care provided.

Dr. Jeff Balser, Vanderbilt University's dean of the School of Medicine, has said, “After having gone through a period where blockbuster drugs and massive screening were the norm, we are actually moving back to a place where we’re trying to tailor care to the individual." EmaxHealth reporter Ruzanna Harutyunyan discusses myths and facts about a family health history.

The group at Vanderbilt also recognizes that personalized medicine encompasses more than just genetics. There is a profound impact on health which also comes from social, family and behavioral factors, as well as environmental and economic circumstances. These things are
seen as being just as vital to help in tailoring health care to the individual as a person's genetic background. At Vanderbilt there are initiatives to combine the University's recognized expertise in health information technology and genetic medicine to help improve personalized medicine. The researchers at Vanderbilt are working hard to determine what potential new models of health care can look like, while showing the rest of the world what’s actually possible.

It has been my observation that personalized approaches to health care are very much desired by many people. Interestingly, what we are seeing is that someone who feels their health care has been suboptimal due to a lack of personalized care now has a great deal of research available to help show there is scientific reasoning behind this assumption. Genetic mapping may very well be opening up new horizons in health care. However, caution must be taken when using this information, while not failing to remember there are also other vital aspects to a consideration of good personalized medicine.

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