The Promise of Precision Medicine
In 2015, then-President Barak Obama announced the foundation for the Precision Medicine Initiative. This comes on the heels of the completion of the Human Genome Project in which the human genome was fully sequenced – 6 billion in all. At that time it was thought to be the beginning of the end of all disease. Although that promise has been elusive, the theory still persists. The basis of this theory is that all diseases have a root cause and if one can get to that cause, the disease will resolve.
The most elegant example of this model is largely in the realm of cancer, particularly leukemia. There are a few varieties in which the there is a particular genetic marker. If present, there is a likelihood of the existence of a particularly biochemical defect which may be playing a role in the condition. When a particular treatment is targeted to this vulnerability then there may be a successful response, compared to a standard chemotherapy regimen. So potentially, diseases with a single biochemical cause can be eliminated using a single medication. So, this is the vision as it currently stands.
The Challenge
However, the industrialized West has been in a great struggle against chronic disease. Other than cancer, examples of these include autoimmune diseases, arthritis, as well as metabolic syndrome which is hallmarked by obesity, hypertension, high cholesterol, and insulin resistance which then may lead to heart disease, diabetes, and cognitive decline. The strategy thus far employed against these diseases has remained the same. If there is a receptor, then either block it or stimulate it. If there is over-activity, then blunt it. If there is under-activity, then arouse it. The results of this method have been frustrating and unrewarding, and undeniably expensive. Generally this has resulted in more and more medications or devices.
More recently, there has been building interest that our current model of chronic disease is incomplete. Many of these Western diseases appear to be syndromic, meaning that the disease that we experience may be an expression of many causes. The complex disease as expressed may not be the actual problem, but only a symptom, and that the root cause remains still yet elusive. The condition that has received recent attention is Alzheimer’s dementia. With this disease, there have been described anatomic derangements, metabolic concerns, and genetic vulnerabilities, all of which are associated with ongoing inflammation. The brain’s response is to decrease its activity, which then creates the final symptom of memory loss. Recognizing that there are multiple “holes” needing to be addressed is in the realm of Precision Medicine.
The Vision
Utilizing this new model of disease would suggest that a single drug to cover a single “hole” is unlikely to be effective when a dozen others still exist to perpetuate the problem. If Precision Medicine were to be applied for Alzheimer’s dementia, the preferred treatment would be that of a strategy or a protocol, rather than a single drug. Medications may be part of the strategy, but the mainstay will be lifestyle management.
The attractiveness of this idea, that the human body should be able to thrive, is modeled after the “Blue Zones,” areas around the world where people live to be over 100 and chronic disease is not part of its experience. The human body has systems which are remarkably adaptable despite the varying climates, food types, and conditions found on the planet. However, these systems in an industrialized world can be easily overwhelmed. The first goal of Precision Medicine is to understand the limits and tolerances of those functional systems. The second, of course, is to rebalance them.
Additional Information:
The Precision Medicine Initiative From The Obama White House
Memory loss associated with Alzheimer’s reversed for first time
