Gathering the Ingredients for Precision Medicine

September 12, 2017
By Josh Baxt, BioSpace.com Breaking News Staff

I cook a lot, but I’m not very organized about it, which can lead to interesting results. Sometimes we’re out of sage, and I substitute rosemary. It works okay. My family gives me quizzical looks, but they really don’t want to know.

If you check out the agenda for the recent Precision Medicine Leaders Summit in San Diego, it reads a little bit like a recipe: biomarkers, big data, proteomics, wearables, artificial intelligence, diagnostics. These are some of the ingredients we are going to need to make precision medicine work. The big question is whether we’ve advanced enough with any of these to go full-bore into the clinic.

My favorite session title was Biomarker Purgatory: Why so many Biomarkers Discovered but so Few Successes? It really encapsulates the conference’s underlying question: Are we there yet?

We’ve been talking about precision medicine for decades. The name changes—individualized, personalized, precision—but the concept remains basically the same. What if we could custom-tune approaches to meet people where they live? Cancer therapies could be targeted to each patient’s unique set of mutations; heart failure patients could have devices that monitor their hearts continuously and algorithms to titrate their medications; precise diagnostics could detect diseases early, when they are most treatable.

These are all incredibly powerful concepts that spark our imaginations. Perhaps that’s why precision medicine has been five years away for the past 15 years.

Still, conference speakers were generally unflinching in their efforts to diagnose what may be slowing progress. The life sciences industry is a disparate group of scientists, investors, small startups, big pharma, payers. They’re not always talking to each other.

For example, diagnostics companies can have trouble finding investment because reimbursement is often low and investors don’t see the ROI. On the other hand, payers wonder why diagnostics people don’t ask them what’s needed before they develop a product.

Data is another sticking point. Next generation sequencing (NGS) can find multiple mutations in any given tumor. But which ones are actionable? Which ones drive the cancer? Population and other studies will answer these questions, but they’re just getting started. Lower-cost NGS is enabling all kinds of research, and even clinical advances, but the ability to crunch major data will be a key ingredient.

We also need to map out how these approaches will be integrated into clinical care. Wearable devices can produce thousands of data points, but are they valuable if an overwhelmed physician doesn’t have time to look? The same could be said about NGS.

Still, the technology is moving fast, and there is tremendous enthusiasm. Connected pills (or pill bottles) are helping patients maintain compliance. On the big data front, a 2016 study used BING web searches to detect undiagnosed pancreatic cancer. Another study used Instagram to predict depression.

As always, the concept of precision medicine is inspiring. It’s just that we haven’t assembled all the ingredients yet. This may be the rare case where we need more chefs in the kitchen talking to each other.

So, are we there yet? Perhaps another five years.

Josh Baxt has been a science and healthcare writer for more than 18 years, working at Scripps Health and the Sanford-Burnham Medical Research Institute before going freelance in 2011. He writes about molecular biology, genomics, pharmaceuticals, emerging medical technologies, regulation and public policy. He is based in San Diego.