{"id":7578,"date":"2011-04-18T11:50:32","date_gmt":"2011-04-18T15:50:32","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=7578"},"modified":"2011-04-18T11:59:42","modified_gmt":"2011-04-18T15:59:42","slug":"personalized-medicine-the-concept","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2011\/04\/18\/personalized-medicine-the-concept\/","title":{"rendered":"personalized medicine: the concept…"},"content":{"rendered":"\n
Personalized Medicine is certainly the phrase of the hour, originating in response to the mapping of the human genome. The idea of precise genetic typing opens the door to possibilities previously only dreamed of in medicine and has pulled research in that direction like a powerful electromagnet. It’s called Personalized Medicine because it opens up possibilities for treatment directly tailored to the genetic make up of the individual. It must be important because it’s already in Wikipedia<\/font><\/strong><\/u><\/a>: <\/div>\n
\n
Personalized medicine<\/strong> is a medical model emphasizing in general the customization of healthcare, with all decisions and practices being tailored to individual patients in whatever ways possible. Recently, this has mainly involved the systematic use of genetic or other information about an individual patient to select or optimize that patient’s preventative and therapeutic care.<\/sup><\/div>\n

Over the past century, medical care has centered on standards of care based on epidemiological studies of large cohorts. However, large cohort studies do not take into account the genetic variability of individuals within a population. Personalized medicine seeks to provide an objective basis for consideration of such individual differences. Traditionally, personalized medicine has been limited to the consideration of a patient’s family history, social circumstances, environment and behaviors in tailoring individual care.<\/sup><\/p>\n

Advances in a number of molecular profiling technologies, including proteomic profiling, metabolomic analysis, and genetic testing, may allow for a greater degree of personalized medicine than is currently available. Information about a patient’s proteinaceous, genetic and metabolic profile could be used to tailor medical care to that individual’s needs. A key attribute of this medical model is the development of companion diagnostics, whereby molecular assays that measure levels of proteins, genes or specific mutations are used to provide a specific therapy for an individual’s condition by stratifying disease status, selecting the proper medication and tailoring dosages to that patient’s specific needs. Additionally, such methods can be used to assess a patient’s risk factor for a number of conditions and tailor individual preventative treatments…<\/sup><\/div>\n<\/blockquote>\n
And that magnet has attracted a consortium of business and academic supporters: <\/div>\n
\n
The Case for Personalized Medicine
Executive Summary<\/font><\/strong><\/a><\/u>
The Personalized Medicine Coalition<\/font><\/strong><\/a><\/u><\/div>\n
from The Age of Personalized Medicine <\/font><\/strong><\/a><\/u> <\/div>\n

A tectonic shift is taking place in medicine. For the average patient the movement is subtle, perhaps imperceptible, but ultimately it will affect the entire landscape of our healthcare system. Since the mapping of the human genome in 2003, the pace of discovery, product development, and clinical adoption of what we know as personalized medicine has accelerated.<\/sup><\/p>\n

Personalized medicine may be considered an extension of traditional approaches to understanding and treating disease, but with greater precision. A profile of a patient’s genetic variation can guide the selection of drugs or treatment protocols that minimize harmful side effects or ensure a more successful outcome. It can also indicate susceptibility to certain diseases before they become manifest, allowing the physician and patient to set out a plan for monitoring and prevention. Physicians can now go beyond the "one size fits all" model of medicine to make the most effective clinical decisions for individual patients.<\/sup><\/p>\n

Personalized medicine offers a structural model for efficient healthcare. It is preventive, coordinated, and evidence-based. It relies on a network of electronic health records that link clinical and molecular information to help patients and physicians make optimal treatment decisions. It is proactive and participatory, engaging patients in lifestyle choices and active health maintenance to compensate for genetic susceptibilities…<\/sup><\/div>\n<\/blockquote>\n
Personalized Medicine has even recently had its first sure-enough classy scandal when Dr. Anil Potti at Duke abruptly resigned when his genetic markers for lung cancer chemotherapy were exposed as fallacious [junk science<\/em> on the leading edge<\/em>…<\/font><\/a><\/strong>, overlooked…<\/em><\/font><\/a><\/em><\/strong>, <\/em>industry on parade once again…<\/font><\/a><\/strong>].<\/div>\n

<\/p>\n

In Psychiatry, we are on the bandwagon. This from the Director of the NIMH [notice the diagonal arrow on the figure]: <\/div>\n
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Psychiatry as a Clinical Neuroscience Discipline<\/a>
NIMH: Director’s Blog<\/strong>
by Thomas R. Insel, MD; Remi Quirion, PhD, FRSC, CQ <\/div>\n
In this commentary, we argue that psychiatry’s impact on public health will require that mental disorders be understood and treated as brain disorders.<\/em><\/sup><\/div>\n
…<\/sup><\/div>\n
Where to Go From Here?<\/font><\/strong><\/sup><\/div>\n
The 1990s were identified as the "decade of the brain" with major new insights into brain circuitry and function. The current decade may be recognized in retrospect as the "decade of discovery," during which many of the major candidate molecules, cells, and circuits for normal and abnormal brain function will be identified for the first time. A goal of the Decade of Discovery must be the description of the basic pathophysiology of each of the major mental disorders [Figure 1<\/a><\/strong>].<\/sup><\/div>\n
<\/div>\n

…Clinical neuroscience can now look forward to an "era of translation" with more accurate diagnoses and better treatments as well as very early detection and prevention. Early detection will require a thorough understanding of risk, based on a comprehensive understanding of genetics and experience. For example, preventive interventions might be available to prevent a first psychotic episode in an adolescent at high risk for schizophrenia.<\/sup> <\/p>\n

Conclusion<\/font><\/u><\/strong><\/sup><\/div>\n
At the intersection of an age of discovery in the neurosciences, behavior, and the complexities of human mental life, psychiatry should emerge once again as among the most compelling and intellectually challenging medical specialties. This promise of the future will depend on psychiatry’s incorporation of the insights and tools of modern neuroscience, integration into the mainstream of medicine by focusing on the public health needs of those with mental disorders, and retention among the medical specialties of a unique focus on the contribution of human experience and behavior to health and disease.<\/sup><\/div>\n<\/blockquote>\n
And none are more enthusiastic than the leaders of BRAINnet<\/strong> and Brain Resources<\/strong>:<\/div>\n
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Personalized medicine for the brain: a call for action<\/font><\/strong><\/a>
by SH Koslow, LM Williams and E Gordon
Molecular Psychiatry<\/font><\/strong> (2010) 15, 229–230.<\/div>\n

<\/p>\n

Disorders of the human brain, such as depression, schizophrenia and addiction, are the cause of immeasurable human suffering. As they are largely chronic and strike in youth, brain disorders lead to greater disability and loss of productivity than any other category of illness. On 24–25 October 2009, leaders from the fields of research, medicine, industry, government and philanthropy convened at the Mayflower Hotel inWashington DC to launch an initiative fostering personalized medicine for the brain. The Mayflower Action Group Initiative was instigated by BRAINnet, a new non-profit foundation that provides a database on the human brain using standardized methods…<\/sup><\/div>\n<\/blockquote>\n
If you don’t yet know what BRAINnet<\/font><\/strong>, Brain Resources<\/font><\/strong>, or the Personalized Medicine Coalition<\/font><\/strong> are, don’t be impatient – we’ll get to them in due time. For the moment, take a look at the list of the 44 people<\/font><\/a><\/strong><\/u> who were at that Mayflower Action Group Initiative meeting [half of the iSPOT<\/font><\/strong> authors].[hat tip to SteveBMD<\/strong><\/u><\/a>]<\/sub><\/div>\n

<\/p>\n

Notice that the term "personalized medicine" is more expansive in these last two articles than simply genetics and the genome. It has come to mean something like a search for "biomarkers" of any kind at all that might direct the choices of a treatment or the choices among available treatments. Today, "personalized medicine" has joined its predecessor "evidence-based medicine" as the modern things to say – and both have replaced "chemical imbalance" [now fallen into the shadows].<\/div>\n","protected":false},"excerpt":{"rendered":"

Personalized Medicine is certainly the phrase of the hour, originating in response to the mapping of the human genome. The idea of precise genetic typing opens the door to possibilities previously only dreamed of in medicine and has pulled research in that direction like a powerful electromagnet. It’s called Personalized Medicine because it opens up […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-7578","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/7578","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=7578"}],"version-history":[{"count":36,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/7578\/revisions"}],"predecessor-version":[{"id":44828,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/7578\/revisions\/44828"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=7578"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=7578"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=7578"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}