By John Shea
Personalized? Or Individualized? Genomic, perhaps? Or Precision? What to name this new kind of medicine? As many longtime medical practitioners insist, the best medicine has always been “personalized,” focused on the patients they are treating. So perhaps “precision medicine” is more accurate for what is currently developing. This issue’s cover story recounts what’s been happening at Penn with precision medicine.
Precision has a nice sound to it. Years ago, the graduate students teaching Freshman English to Penn students held a Halloween party. Having come up for air after a long stretch of grading essays, I decided to attend as a new superhero: Captain Correcto. I wore borrowed plastic goggles and probably made do with a long blue towel for a cape. On my chest, I had affixed a cardboard crest with these words: CLARITY & PRECISION.
Captain Correcto had a very short life, but I’ve continued to appreciate precision when it’s called for. So I observed with interest as what was then “personalized medicine” a dozen years ago is now almost universally recognized as “precision medicine.” Even the Federal government is on board, as shown when President Obama delivered his 2015 State of the Union Address and called for a national Precision Medicine Initiative. This is not the first time he has shown interest in this kind of medicine. In August 2006, as a U.S. Senator, he introduced the Genomics and Personalized Medicine Act, which he claimed would help scientists tap the power of genomics to find treatments for disease. The bill was not enacted. This time, things are different, as the president’s initiative has added $215 million to the federal budget and more and more institutions are pursuing precision medicine.
A few days after the State of the Union Address, President Obama asserted that precision medicine “gives us one of the greatest opportunities for new medical breakthroughs that we have ever seen. . . . What if figuring out the right dose of medicine was as simple as taking our temperature?” He clearly stated the basic premise – and promise – of precision medicine: “delivering the right treatments, at the right time, every time, to the right person.” His words have a familiar ring. On the home page of Penn’s new Center for Precision Medicine: “The practice of precision medicine is about providing the right treatment (or prevention) to each individual at the right time.”
The need for more precision seems very clear when medications are involved. In April 2015, Nature ran a full-page infographic (“Imprecision Medicine”) showing that for every person that the ten highest-grossing drugs in the United States do help, they fail to improve the conditions of between 3 and 24 people. Even more frightening, the article noted that for some drugs, such as statins, it may be as few as 1 in 50 who benefits.
Although precision medicine seems to have won the field, there remain some wary observers. In 2007, Penn Medicine reported on a symposium organized by Penn’s Institute for Translational Medicine and Therapeutics. Its title: “Personalized Medicine: Boon or Pipe Dream?” Two years later, the Penn Genome Frontiers Institute was one of the hosts of another symposium on personalized medicine. The consensus: challenges still remained. More recently, a publication of Penn’s Leonard Davis Institute of Health Economics ran “Personalized Medicine: The Promise and Perils” (March 2013). Several Penn Med faculty members were quoted, including Jason Karlawish, M.D., a professor of medicine: “As a society, we’re going to need to start to think about the ethical, legal, and social implications of this. . . . It’s a new model that presents novel challenges.” Even Jason H. Moore, Ph.D., featured in the current issue, notes that precision medicine “is a fundamental change in the practice of medicine, and it will require some time to sort out.” To be precise, the future may be closer, but it’s not here yet.