We are entering a time when the dream of personalized medicine will become a reality. Instead of treating patients in a one-size-fits-all fashion, clinicians will use information technology and medical genetics to provide a focused, individualized approach to health care.

Personalized health care encompasses prevention, diagnosis, and therapy, with a patient's risk for disease defined through genetics as well as through clinical and family histories. Scientists have begun to understand diseases at the molecular level, allowing clinicians to see how those diseases manifest in individual patients and to tailor treatment more effectively. Genetic predisposition testing and pharmacogenetic testing will allow asthma treatment to be optimized, for example, or warfarin dosing to be better managed. In a personal communication, Alan Guttmacher, MD, Deputy Director of the National Human Genome Research Institute, told methat “genomics will irrevocably change how we practice medicine, enabling us for the first time to treat each patient truly as the individual person he or she is and thus dramatically [improve] the quality of health care.”

Genomic medicine at present can be compared to the computer industry in the 1980s. As time passes, we will witness the transformation of genomic and proteomic science. These scientific advances, combined with progress in information technology, are giving new life to researchers, health care providers, and patients, forever changing the methods used for preventive, diagnostic, and therapeutic activities.1

Yet we are right to be cautious about this seemingly expansive future. Personalized health care is largely prevention-based, in contrast to the current delivery model, which services the acutely ill. Reimbursement will be problematic under the new model—and disparities in access to care and the need for universal health insurance still must be addressed. Also of concern is the use of genetic profiles to predict disease.

Racial and ethnic disparities in health are based on access to quality care, health risk behaviors, psychosocial factors, acculturation, biological/genetic factors, environmental and occupational exposures, and socioeconomic status. According to the National Coalition for Health Professional Education in Genetics Race, Genetics and Healthcare DVD, race may be mistakenly used to indicate ancestral origin. For example, a clinician may assume that a patient is African-American when, in reality, that person is Dominican. The two may have very different health care needs based on ancestral inheritance. When a patient's group identity might raise health issues, ancestry should replace race in discussions.

As predicted in the Mayo Clinic Proceedings, “the possibility of loss of confidentiality, issues of group stigmatization, and the difficult issue of genome predestination must all be addressed if humankind is to reap the full benefits of the potential of this exciting new science.”2 To protect an individual's personal information, Rep. Louise Slaughter (D-NY) introduced HR 493, the Genetic Information Nondiscrimination Act of 2007. This bill prohibits discrimination on the basis of genetic information with respect to health insurance and employment. Its passage would remove a potential barrier to the use of genetic testing and other genetic services.

The Personalized Medicine Coalition is an independent, nonprofit group that works to advance the understanding and adoption of personalized medicine for the ultimate benefit of patients. They have stated that “in considering whether personalized medicine has a viable future, a look into the past reveals that it has always been here in some form. But in its modern manifestation, which relies on molecular analysis and proactive care, personalized medicine will require an extensive system of support. This system will include new regulatory approaches, revamped medical education curricula, integrated health information systems, legislation to protect against genetic discrimination, insurance coverage for sophisticated molecular diagnostic tests, and a reimbursement system that encourages proactive care. Because of the many hurdles before it, some experts have questioned whether personalized medicine will become a dominant trend in healthcare, or just a passing phase.”3

Most providers still assume that genetics and genomic medicine are not applicable to their current practice. Yet an understanding of what can be learned about personalized medicine now and throughout their clinical careers will help PAs to use genetic information to diagnose common diseases sooner, when treatment can be most successful, and to identify how diseases can be managed more effectively. For this process to be a success, however, we must commit ourselves to ongoing learning about how this new knowledge will help us take care of patients. JAAPA

Michael A. Rackover, PA-C, MS, is Program Director and Associate Professor in the PA program at Philadelphia University, Philadelphia, Pa. He recently completed a sabbatical at the National Human Genome Research Institute.

REFERENCES

1. IBM Executive Brief. Personalized healthcare 2010: are you ready for information-based medicine? Available at: http://www-03.ibm.com/industries/healthcare/doc/content/resource/insight/992104105.html. Accessed April 10, 2007.

2. Weinshilboum RM. The genomic revolution and medicine. Mayo Clin Proc. 2002;77(8):745-746. 3. Personalized Medicine Coalition. The case for personalized medicine. November 2006. Available at: http://www.personalizedmedicinecoalition.org/communications/TheCaseforPersonalizedMedicine_11_13.pdf. Accessed April 10, 2007.