Future Direction…

What if we could understand health and complex diseases BEFORE they occurred using personalized genomics, informatics, and biology to create a healthcare system that focused on prevention (Snyderman, 2012)?  This outlook on health is the concept best described as “personalized medicine/healthcare”.  The understandings from science are leading the way in changing our thinking about diseases and providing a deeper understanding of the development of diseases overtime based on a person’s genetic background and their exposure to environmental factors (Snyderman, 2012). 

With this concept in mind, what would a clinical best-practice guideline look like? With such a specific and holistic view of patients, having a “one-size fits all” approach to clinical best-practice guidelines would be difficult to create. However, with the focus being more on preventative and personalized medicine, clinical best-practice could be changed to medical guidelines based on subsets of the population (Antonanzas, Juarez-Castello, & Rodriguez-Ibeas, 2015).  Genetic testing would allow for the stratification of the population subsets which would provide information on treatments to support decision making on personalized medicine (Antonanzas, Juarez-Castello, & Rodriguez-Ibeas, 2015).  To be able to understand a person’s disease susceptibility as well as the best course of treatment based on their genetic make-up, will allow for a more personalized, predictive, preventative, and person-centered approach to care (Snyderman, 2012). 

In the research process to develop these recommendations, specific research modalities will need to be incorporated in order to utilize personalized medicine.  To better understand disease risk, research will need to focus on the development of diseases based on a person’s health status and risk.  This could be tracked using a longitudinal research project that focuses on human traits and health with a focus on genomes (Lifescience BC, 2017).  There is a project in British Columbia that is looking to implement personalized medicine.  The recommendation from this study was to study major disease states from certain communities and cohorts (Lifescience BC, 2017).  From this, socioeconomic, age, sex, ethnicity, genomic analysis, proteomic, metabolomics, and microbiomic data would be collected and analyzed (Lifescience BC, 2017).  By combining this information, clinicians could identify biomarkers that are associated with disease and provide information on the best way to optimize health and utilize healthcare resources (Lifescience BC, 2017).

Using this approach to healthcare, there are legal and ethical considerations to be aware of…

  • Genetic discrimination – test results affecting a patients ability to receive health insurance
  • Psychological impact of understanding genetic risk factors
  • Ensuring proper consent is obtained prior to genetic testing (Callier, et al., 2016)

Personalized medicine is not an entirely new concept in our modern day healthcare system.  There are many examples of bio markers and evidence of the efficacy of these treatments.  Examples such as:

https://www.ctvnews.ca/video?clipId=588080

Using advancements in research, personalizing medicine is a concept that will continue to evolve in our everyday practice. Nurses will need to continue to integrate best practice and evidenced based knowledge into their everyday practice to support the advancements made in personalized medicine.

References

Antonanzas, F., Juarez-Castello, C. A., & Rodriguez-Ibeas, R. (2015). Some economics on personalized and predictive medicine. The European Journal of Health Economics, 16(9), 985-994.

Callier, S. L., Abudu, R., Mehlman, M. J., Singer, M. E., Neuhauser, D., Caga, A. C., & Wiesner, G. L. (2016). Ethical, Legal, and Social Implications of Personalized Genomic Medicine Research: Current Literature and Suggestions for the Future. Bioethics, 30(9), 698–705.

Cutter, G. R., & Liu, Y. (2012). Personalized medicine: The return of the house call?. Neurology. Clinical practice2(4), 343–351. doi:10.1212/CPJ.0b013e318278c328

Lifescience BC. (2017, June). The time is now for personalized medicine in british columbia. Retrieved from Lifescience BC: https://lifesciencesbc.ca/wp-content/uploads/2018/01/Roadmap-2.0-Time-is-Now-for-Personalized-Medicine-in-BC-Final.pdf

Snyderman, R. (2012). Personalized health care: from theory to practice. Biotechnology Journal, 7(8), 973-979.

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