We may finally be at the threshold of the age of personalized medicine. In a recent study, scientists were able to predict that a man was at a higher risk for developing Type 2 diabetes and over a two-year period tracked his health as he developed the disease. And even better, because they caught it so early, they were able to stave off the diabetes with lifestyle changes. This man’s glucose levels have returned to normal.
Wow. This story highlights the promise of at least one aspect of personalized medicine. By looking at someone’s DNA, you can predict what might go wrong with someone and so keep an eye out for early symptoms. Or maybe even start out with the right lifestyle changes that will keep the disease from developing in the first place.
This study also showed that intensely studying a single person can yield potential benefits for lots of other people. The researchers saw that just before the test subject’s glucose levels spiked, he had a viral infection. No one was really looking for viruses that trigger Type 2 diabetes in people. Now they will. (Keep in mind we don’t yet know if the two are connected or if it was just a coincidence.)
The study also points to the obstacles we still need to overcome to realize the full potential of personalized medicine. The top ones I could think of off the top of my head are our own ignorance, the inconvenience, the expense, and our lack of willpower.
The researchers were able to predict an increased risk for diabetes as well as an increased risk for high triglycerides but very little else. There is certainly more information lurking in his DNA…we just don’t understand our DNA well enough to tease it out yet.
Another related issue is whether we actually do know enough to make good predictions or if we just got lucky here. In other words, was his developing Type 2 diabetes a coincidence or was he really at a higher risk for getting it? He didn’t have any classic risk factors but given that so many people in the U.S. have the disease, it could have been chance. Doing many more studies on lots of different people should give us some idea about how predictive our DNA really is right now.
Besides our still sketchy knowledge, we also have to deal with the expense and inconvenience of this form of personalized medicine. The test subject had over twenty blood draws over a two year period that each looked at tens of thousands of different things. Not many people would put up with so many blood draws. And the expense of looking at all those different molecules is prohibitively expensive.
A better knowledge of our risks can help with the second point. Once we understand our DNA better and so know what are most likely risks are, we’ll be able to test for fewer molecules which should make the whole thing more affordable. This may also solve the first problem too.
Maybe in the future we’ll look at few enough molecules or the tests will be sensitive enough to get the information we need from a simple finger prick. Then we’d all be like folks with diabetes, self testing our blood on a regular basis. And hopefully in the more distant future, we’ll have some sort of implant that reads the information for us automatically without the need for a blood draw.
All of these are technical hurdles that will almost certainly be overcome at some point. The last obstacle, though, is much more difficult. It deals with human nature.
One reason this is such a powerful story is that the test subject was able to get his glucose under control without the use of medicines. This is not only good for him but it suggests that this form of personalized medicine may prove to be cost effective sooner rather than later. Keeping his Type 2 diabetes at bay will probably save tons of money over his life time. Perhaps even enough to justify the cost of his testing.
But to control his glucose levels, he had to make radical changes to his diet and exercise regime. He had to eat a whole lot less sugar and fat and exercise a lot more. Sound familiar?
Everyone should be doing this stuff anyway but most of us don’t. Will we have the willpower to realize the full potential of personalized medicine? Or will things pretty much stay the same except with more frequent scolding from our doctors?
Of course, catching a disease early and getting patients their medications early when it could do the most good is obviously wonderful too. Just not as cost effective.
What a visit to the doctor in the near future might look like.