personalized medicine

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Personalized Medicine Distracts From Public Health, 2 Scholars Argue

Personalized medicine is all the rage. President Obama mentioned it in his State of The Union address this year and launched a multimillion-dollar initiative to push a personalized medicine agenda forward. The head of the National Institutes of Health has made it a priority. And really, what’s not to like about the general concept of medicine that’s personalized (it’s also called “precision medicine”) —  an approach that analyzes an individual’s genetics to make medical decisions about diagnosing and treating disease.

Well, two public health scholars argue in the New England Journal of Medicine that the current high-profile fawning over personalized medicine may be a “mistake” that diverts resources away from other public health efforts that could benefit far more people.

Ronald Bayer, Ph.D., a professor at Columbia University’s Mailman School of Public Health, and Dr. Sandro Galea, dean of the Boston University School of Public Health, write in the journal that the great enthusiasm around personalized medicine “derives from the assumption that precision medicine will contribute to clinical practice and thereby advance the health of the public.” But, they note, that may not be the case:

We suggest, however, that this enthusiasm is premature. “What is needed now” is quite different if one views the world from the perspective of the broad pattern of morbidity and mortality, if one is concerned about why the United States has sunk to the bottom of the list of comparable countries in terms of disease experience and life expectancy, or if one is troubled by the steep social gradient that characterizes who becomes sick and who dies. The burgeoning precision-medicine agenda is largely silent on these issues, focusing instead on detecting and curing disease at the individual level…

Without minimizing the possible gains to clinical care from greater realization of precision medicine’s promise, we worry that an unstinting focus on precision medicine by trusted spokespeople for health is a mistake — and a distraction from the goal of producing a healthier population.

I spoke with Dr. Galea about why he and Bayer targeted personalized medicine, in particular. Here, lightly edited, is what he said:

Personalized medicine has become this rallying cry around resource allocation in the health sciences. The president mentioned in the State of the Union. There is a White House precision medicine initiative, and it has dominated much of the NIH agenda…so it seems important to address it directly…

Nobody is arguing that precision medicine does’t have potential, but the number of people who you could point to who have actually benefited from it are very small. And so we are investing in potential — which is fine — but it’s a matter of calibrating our investment. Instead of investing in a untried, untested approach, we should be investing in things that we know make a difference…

We know that macroeconomic taxation on unhealthy substances, on alcohol, for example, can save thousands of lives, early childhood education can make an enormous difference, efforts to increase and improve vaccination rates, efforts to mitigate cycles of violence, one could go on and on….these could improve the lives of hundreds and thousands of people…

Our commentary was a call for a recalibration…I think there’s a feeling in the scientific community that the precision medicine agenda is becoming the overwhelming direction in which we are headed and that we would benefit from discussion and debate and a more careful calibration of the questions we ask and where we invest our resources.

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Personalized Cancer Test Pinpoints Best Drug For Patients

By Alison Bruzek

Cancer, whether in the pancreas, the ovaries or the liver, can take on different characteristics and spread in different ways. That’s why, unfortunately, there’s no one-size-fits-all drug to help patients fight back.

But a new, quick test can personalize treatment and help oncologists choose which chemotherapy route to take.

The test, called Dynamic BH3 Profiling, quickly predicts whether or not a drug will work for a patient by first trying that drug on a tumor sample in the lab. A paper describing the method, which researchers say could become more widespread within a couple of years, was published in the journal Cell this week.

The idea echoes how we choose the most effective antibiotics, says study author Dr. Anthony Letai, a cancer researcher with the Dana-Farber Cancer Institute.

A new tool for predicting relapse in acute myelogenous leukemia (AML) was developed by Dr. Anthony Letai (Courtesy of Dana-Farber Cancer Institute)

A new tool for predicting relapse in acute myelogenous leukemia (AML) was developed by Dr. Anthony Letai (Courtesy of Dana-Farber Cancer Institute)

“When we’re trying to choose antibiotics for people … we simply isolate the bacteria that’s causing the problem and expose it to all the drugs that are available,” he says. Then researchers choose the drugs that best put a lid on the multiplying bacteria.

“That has operated for many, many decades,” Letai says, “so we thought, why not do that for cancer cells?”

Letai’s team isn’t the first to think of this strategy. “People have tried to do this kind of thing in years past but there have been a variety of advances in technology … that make it more feasible this time around,” says Levi Garraway, a cancer researcher at Dana-Farber who was not involved with the study.

What’s different about Letai’s work is its speed: It can quickly determine whether a drug, or combination of drugs, is working. The test looks not at when the tumor cells are dead, but rather when they’re beginning to die.

The ‘Death Switch’

The researchers found that there is a point of no return, a threshold of doom, when cells begin to die that is indicative of their actual death. The team looked at varying types of cancer cells (breast, lung, melanoma) and saw that there was essentially a death switch that when flipped on, ensured the cell’s destruction.

Examining if a cancer drug flipped this switch, instead of waiting to see if the cells would eventually die, allowed the researchers to know, in about 16 to 24 hours, which drugs were working. Continue reading

Coming Someday Soon: Your Own Implantable Medicine Cabinet

An image of the new microchip and where it would be implanted

By Karen Weintraub
Guest Contributor

The thought of having to stick yourself with a needle is pretty unappealing, even if it’s to inject essential medicine.

Now, researchers at MIT and a local biotech company have announced the development of an implantable device that delivers drugs from the inside. Think of Norplant – the now discredited birth control method implanted in the upper arm that was supposed to protect us from our own forgetfulness.

This device – which won’t be ready for patients for another four years at least – would be better, its developers say, because it would release a precise dose at a precise time.

About the size of a flash drive, the device would have 365 tiny compartments, potentially carrying different doses and different drugs. It could be wirelessly reprogrammed by a doctor if the dose needed to be changed.

“That really translates into freeing patients from the burden of managing their disease on a daily basis,” says Robert Farra, president, and chief operating officer MicroCHIPS, Inc., the Bedford company that is developing the device. Patients would “no longer have to remember [to take their medications] or deal with pain of injection.” Continue reading

‘Provocative Questions’ And More At New Science Museum Exhibit

It sounds like a chamber straight out of Hogwarts: The Area of Provocative Questions

But no, it’s part of an ambitious, forward-thinking new exhibit that focuses on personalized health, human biology, public policy and more at Boston’s Museum of Science: The Hall of Human Life, a renovated 15,000-square-foor space that visitors will enter through a huge, semi-transparent membrane.

Paul Fontaine, the museum’s vice president of education, said the Provocative Question area will challenge visitors to explore their own own beliefs and the outside forces that shape them. The questions might include:

-Should high schools delay their start time because of sleep needs of teen-age students?
-Should genetically modified foods be acknowledged in packaging and advertising?
-Should the state of Massachusetts control fluoridation in the public water supply?
-Should the drinking age be lowered to eighteen?
-Should the FDA regulate natural supplements and herbal remedies?
-Should cell phone use in cars be banned?

The exhibit, slated to open in July 2013, will also house a “living lab,” where working scientists in biology, neuroscience, cognitive development and other areas will conduct research with consenting museum-goers. “People will get a chance to talk to real scientists and researchers,” Fontaine said, and it will also give lab-bound scientists an opportunity to get out into the real world a bit.

Perhaps the coolest part of the exhibit, which just received a $5 million grant from the Massachusetts Life Sciences Center, is an interactive exploration of personalized health and how to manage it. Each visitor will get a bar-coded bracelet Continue reading