Science Club: Personalized Medicine- Part 1

What is the problem with the current paradigm of medicine?

Here's an analogy:

• Let's imagine that you're sick. You go see a doctor and the doctor prescribes you some medicine.

• Does the doctor know whether this medicine is going to help you get better?

• The answer is probably not.

• What they do know is that during phase III clinical trials, 5 out of every 10 people with symptoms similar to you benefited from the drug and got better.

• This could be as low as 1/10 or as high as 9/10.

I find this problematic. Fundamentally the way the drug is being prescribed has little to do with you.

If we assume you haven't taken this drug before, the doctor does not know how you specifically will react. They know how the general population will react- whether this is 5/10, 1/10, or 9/10 recovering- but not you specifically. The way we approach medicine is a sort of one-size-fits-all approach. You and your friend could be given the exact same drug (since you have the same disease) even though you're different people. You could have no reaction to the drug while your friend could recover from the drug. Alternatively, you could suffer hair loss, vomiting or even die from the drug while your friend could experience none of these.

(From https://blog.crownbio.com/pdx-personalized-medicine#_; this is not my image) If you look at the image, the doctor has no idea which subset of the population you will be part of- effect, no effect or adverse effects.

According to the BMJ, 1/3 medical treatments have a proven benefit to patients (2/10 for cancer drugs) and 7000 people died from medical drugs in the US in 2018 alone.

What if we could prescribe drugs knowing how someone will react to the drug. This is what personalized medicine hopes to achieve. Generally, it is a better way of treating a disease, where the diagnosis and treatment is based on a patient's genome rather than on clinical trials. Hopefully this would maximise efficacy and minimise side effects of a drug. As Hippocrates said 'it is more important to know what sort of person the disease has, than to know what sort of disease the person has.'

Why is cancer?

First of all, cancer is a huge problem. It is one of the main causes of deaths in the US with 600,00 cancer-related deaths in 2018 in the US alone. Half of men will have cancer with 1/4 dying from it. It is 1/3 and 1/5 for women.

Generally cancer is caused by an accumulation of cell mutations causing the cell to divide uncontrollably, resulting in a tumour. The difficulty with treating cancer is that it the type and cause of cancer varies greatly from person to person. Cancer is not a single disease but rather a group of over 100 diseases, caused by different genetic and environmental factors and the differing physiologies of people and their cancers makes it very impractical to use the 'one size fits all' approach to cancer treatment.

A more precise way is required to screen for and treat the disease.