The End of “One-Size-Fits-All” in Medicine

Tisha Parikh (Honours Life Sciences – 2023)

In today’s age, everything from clothing to housing to cars can be customized. We alter things to our liking and do not have to worry about this concept of “one-size-fits-all.” So why should medicine be any different? The emerging concept of precision medicine works to answer this question (1).

In the past, people with the same condition have been prescribed the same drug or therapy with some consideration for factors such as age, sex, weight, or medical history. Despite this, there are still many people for which that medication simply does not work (2). Therefore, we need an approach that specializes treatment for everyone and works by better classifying patients into groups (2).

Precision medicine is much more than matching a blood-type for a transfusion. Precision medicine uses an individual’s genetics, behaviours, and personal environmental factors to create a solution for their healthcare needs (1,3). In medicine, there are always so many external factors that come into play when we prescribe medications or recommend lifestyle changes (3). By gathering information across populations and communities, specific biomarkers can be linked to groups of people, and as a result, be used in targeted treatment or therapy (4). Rather than “personalizing” medicine for any one individual, precision medicine has to do with combining genetics and environments for similar people to find narrowed treatment options that are likely to work and provide optimal benefits (4).

Benefits of such an approach to medicine include higher chances of recovery, as the treatment provided to you has worked for people just like you. Healthcare costs are reduced as treatments are likely to work the first time around (5). Diagnostic equipment use will decline as providers have a reasonable estimate of the issue at hand and can skip directly to specialized technology. A decline in wait times and the process of going from doctor to doctor will follow because your primary provider will have a better idea of where to start and what the problem may be, based on your community or lifestyle. The goal of precision medicine is to get rid of the trial-and-error aspect of medicine to save time, money, and resources. It functions to help people as early as possible in getting treatment and thus recovering (4,5).

Precision medicine is attainable because of the rapid data collection available. An attempt to find relationships between biology, lifestyle, and environment has already been put forth by the Obama government starting in 2015 (4,6). All of Us is an initiative under the National Institute of Health (NIH) that is aimed to create a database to find trends in health conditions among people of similar genetics and/or demographics (6). All of Us is a preliminary effort to provide precision medicine to Americans in the near future (6). In addition to efforts set out by the government, the relative speed and low cost associated with genome sequencing today have accelerated the field towards precision medicine (7). Since sequencing now takes a couple of hours instead of a decade, SNPs, epigenetic alterations, and other molecular predispositions can be found and linked to populations (7).

An example that efficiently highlights the potential of this technology is the story of Melanie Nix (8). In 2008, she was diagnosed with triple-negative breast cancer brought about by a mutation on the BRCA gene, a remarkably common condition for many African American women (8). However, through all the research done on this cancer in African American women, statistics showed that Melanie’s best chance was with a bilateral mastectomy (8). Now cancer-free, Melanie also believes that precision medicine allows a mode for preserving one’s health through targeted therapy (8).

It may just be a matter of time until we see this type of precision become a pillar in medicine. The concept of “one-size-fits-all” has been long lost in fashion and lifestyle, and soon may be a staple of all medical practice.

References

1. Iron Bridge. [Internet]. [Pittsburgh, PA]: Iron Bridge; [date unknown]. How Precision Medicine Will Change Healthcare as We Know it. [cited 2021 December 8]; Available from: https://www.ironbridgecorp.com/blog/how-precision-medicine-will-change-healthcare-as-we-know-it
2. WebMD [Internet]. [place unknown]: WebMD LLC; [date unknown]. Traditional vs. Precision Medicine: How They Differ. [cited 2022 January 8]; Available from: https://www.webmd.com/cancer/precision-vs-traditional-medicine
3. Centers for Disease Control and Prevention. [Internet]. [place unknown]: CDC; [date unknown]. Precision health: Improving health for each of us and all of us. 2020 August 14 [cited 2021 December 8]; Available from:https://www.cdc.gov/genomics/about/precision_med.htm
4. Thermo Fisher Scientific. [Internet]. [place unknown]: Thermo Fisher Scientific Inc.; [date unknown]. A revolutionary shift in the practice of medicine: How a one-size-fits-all approach is becoming history. [cited 2021 December 8]; Available from: https://www.thermofisher.com/ca/en/home/clinical/precision-medicine/precision-medicine-learning-center/precision-medicine-resource-library/precision-medicine-articles/overview-precision-medicine.html#:~:text=Top-,Applications%20of%20Precision%20medicine,generation%20sequencing%20(NGS)%20technology.
5. National Institutes of Health. [Internet]. [place unknown]: U.S. Department of Health and Human Services; [date unknown]. All of us research program overview. [cited 2021 Dec 8]. Available from:https://allofus.nih.gov/about/all-us-research-program-overview
6. National Institutes of Health. All of Us. [Internet]. [place unknown]: U.S. Department of Health and Human Services; [date unknown] [cited 2021 Dec 8]. Available from: https://allofus.nih.gov/
7. Gameiro GR, Sinkunas V, Liguori GR, Auler-Júnior JOC. Precision Medicine: Changing the way we think about healthcare. Clinics (Sao Paulo). [Internet]. 2018 [cited 2021 Dec 8];73:723. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251254/ doi:10.6061/clinics/2017/e723.
8. Evans C. Precision Medicine Is Already Working to Cure Americans: These Are Their Stories. 2015 Jan 30 [cited 2021 Dec 8]. In https://obamawhitehouse.archives.gov/blog [Internet]. [place unknown]. USAGov. [date unknown]. Available from: https://obamawhitehouse.archives.gov/blog/2015/01/29/precision-medicine-already-working-cure-americans-these-are-their-stories