Welcome To The Era Of Personalized Medicine

Personalized medicine is an idea that someday we will all enjoy customized medical care that keeps us healthier. In the meantime, we're stuck with cookie-cutter predictions and trial-and-error treatments.
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There are certain ideas that hover in the ether, hinting at some perfect future where our cars will fly and robots will fetch our slippers. Personalized medicine is one of these - an idea that someday, somehow, we will all enjoy customized medical care that keeps us healthier and enables us to live better and longer. In the meantime, though, we're stuck with the healthcare we have now: an inefficient system with cookie-cutter predictions and trial-and-error treatments.

Part of the problem, so far, is that personalized medicine has often been understood as mostly about drugs - specifically, the idea that one day pharmaceuticals will be tailored to us, individually. This has been slow to happen. Aside from a few cancer drugs like Gleevec and Tamoxifen, the science of pharmacogenomics (the term for matching drugs to specific genetic traits) has been largely a disappointment. And until more personalized drugs emerge from the pharmaceutical pipeline, the thinking goes, personalized medicine will remain a pipedream.

But personalized medicine isn't just about drugs. It's also about data - our personal data, the stuff in our medical records, as well as less clinical information like how much sleep we get or how often we exercise. All this data can personalize our healthcare right now, today - it can be worked back into the equation of how we care for our health, improving decisions like what we eat, how to reduce our risk factors for disease, and what we get tested for (and when). When you start thinking about our healthcare this way, it starts to look like a series of choices, opportunities we have to make better decisions to affect and improve our health. Line all these choices up in sequence from prevention to diagnosis to treatment, and it takes the form of a Decision Tree - which is what I've called my forthcoming book.

Consider, for instance, Lose It!, a free diet tracking tool for the iPhone. Just click on what foods you eat, and the software, using a database of thousands of foods, can calculate the calories and nutritional value of your meal. Choose a weight loss goal and the app will calculate how much you can eat each day to get you there. The easy, engaging tracking tool has become one of the iTunes stores most popular apps.

Or log on to EPSS, short for the Electronic Preventive Service Selector. Based on recommendations by the U.S. Preventive Service Task Force, this free tool (it also comes in iPhone and Blackberry versions) uses a few bits of personal data - your age, your gender, whether you smoke - to crunch a personalized list of recommended screening tests. (Turns out for someone like me - a 41-year-old non-smoking male - there are 10 recommended tests, and 17 not recommended).

Or take a look at Nike Plus, the ingenious exercise system that lets runners track not just how much they've run, but also how many calories they've burned, and how close they are to accomplishing personal exercise goals. More than five million people have discovered that tools like Nike Plus not only make exercise more fun, they also make it more productive.

In this respect, it turns out that personalized medicine is already here. Personalized medicine is what happens when we go online and do our own research at MayoClinic.com before we check in with our doctor. It's what happens when we use iPhone apps to monitor our exercise or weight. And it's what happens when we ask our doctor for our lab test results, and then work with her to make a treatment decision (instead of just leaving it up to them). These tools and opportunities are just the tip of the iceberg though, the first signals of a new mode of healthcare, where individuals will be able to readily track their health and control their healthcare.

Now all this talk about data and statistics can sound intimidating. After all, not all of us are math geniuses, and most of us don't go looking for ways to brush up on high-school algebra. But it doesn't have to be all that scary. After all, we've already gotten used to dealing with numbers and statistical information in all sorts of situations. We manage to handle interest rates when we take out a mortgage. We're quick to calculate prices during a 30 percent Off sale at Macy's. And in our health, many of us already mind our cholesterol level, our blood pressure, and other numbers. If we can handle the math in balancing our checkbook, certainly putting these same skills to work for our health shouldn't be beyond any of our reach. Personalized medicine isn't something that happens to us; it's something that we have to choose to engage in. And the thing is, that's not as hard as it sounds.

Of course, engaging patients is only half of what personalized medicine is about. The other side of the coin requires that healthcare itself get better, in the form of better research and more patient-friendly clinicians. Medicine must be able to deliver more tailored, patient-specific predictions, diagnoses and treatments. This means that geneticists need to keep interrogating the human genome for the links between our DNA and disease, so we can identify our risks earlier. It means biochemists and molecular biologists need to keep spelunking for the biomarkers in our blood that can turn up a disease in its earliest, most treatable stage. And it means that healthcare providers - our doctors, nurses, and nurse practitioners - need to be trained to engage with more informed patients who may be bringing self-generated research and records to the doctor's office.

Thankfully, both components of personalized medicine are making rapid progress. Patient empowerment, long paid lip-service but given little heed by a medical profession steeped in paternalism, has made great strides in recent years, bolstered by the Internet and other consumer technologies. Genetics, proteomics, and other molecular sciences have all made stunning advances the past decade, fueled by bioinformatics (the combination of huge data sets and massive computing power). The pieces are coming together, and personalized medicine is starting to take shape.

In the coming weeks, I'll be sharing some ideas here at the Huffington Post for how personalized medicine is playing out, right now, today. As is so often the case with new tools, engaging in personalized medicine right now takes some work; it's still a piecemeal experience that demands diligence and initiative. But for those willing to do the work and make the effort, the returns can be nothing less than better health and a better life.

Thomas Goetz is the executive editor at Wired Magazine, and holds a master's in public health. His book The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine comes out in February. You can follow him on twitter and read his Decision Tree blog.

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