“Personalized Genomic Medicine: Who to believe”
Similar to one of our latest readings, , translating the knowledge of our genes into actual use in medicine is easier said than done. The article from class was aimed to teach doctors how to speak about genomics to patients. This new article is calling for a new system of personalized medicine. Do you think such a system is possible? Now that you are beginning to understand how environment, epigenetics, and variation create different outcomes from the same genes, how can the intricacies and details of each individuals genome ever be used to form a strict translation and used to inform patients on their health risks?
Is an X equals Y diagnoses ever really possible with so many confounding factors? And are physicians inept enough to be the ones making decisions based on genomes?
(Thank you to one of our past HS320 students for sending this blog in!!)
Caroline Booth:
ReplyDeleteI think this idea of personalized medicine is fascinating and potentially very useful. However, because of the many confounding factors, I'm not sure if it is ever really possible. Because the environment, variation, and epigenetics all play major roles in the determination of one's genome, I think it would be very difficult to simply use a SNP or an insertion/deletion to explain what each patient is at risk for or maybe already has. Epigenetics involves environmental factors that can turn on or off certain sections of a gene. This may not be able to be seen in the simple genome sequence because it is not an actual change in the base pairs, it's just a change on how they're expressed. So how could a doctor explain that part to their patients without having to go into extreme detail and taking up a lot of time? I really don't think this "X = Y" phenomenon is possible at this point. It isn't 100% accurate to say that just because you have a certain SNP then you will certainly develop a specific disease. I think doctors could easily end up confusing and/or worrying patients more than actually helping them to prepare or avoid certain diseases. Also, although doctors are incredibly intelligent, they themselves might not have been the ones doing the genetic research and may not really know all of the in's and out's involved in the process. They may not be fully aware of what sequencing the genome involves and what each outcome can mean because that was not their field of specialty. I think personalized genomic medicine sounds like a very nice idea, but I'm not sure it can really be carried out effectively in practice - at least not yet.
- Caroline Booth
I think Caroline brings up some valid points about personalized medicine and the possible ramifications of this new process. Personalized medicine based on one's genetic factors would completely change the way medicine is approached for all levels of care. For instance, primary care physicians would have to be well versed in the technicalities and details of all of their patient's genetic information. In addition, a tertiary care doctor like a neurosurgeon would also have to be familiar with their patient's data, even if they only are operating on them for one specific episode. This leads to a big problem in the healthcare field: efficiency. If time will be spent to relearn things about medicine based on genes rather than the common symptoms for a particular disease, for instance, then the healthcare field would face some serious issues. Retraining an entire field, including those professions involved with physicians (psychologists, insurance companies, or physical therapists, etc.) would lead to a huge change.
DeleteAdditionally, the use of personalized medicine would invoke complications for patients. Some people are firm believers of "what they don't know can't hurt them." In my opinion, knowing too much about one's genetic makeup may result in too many complications, worries, and stress regarding one's health outcomes. Personalized medicine may have future implications of being a great tool for medicine and diagnostic tools, but I think, at least right now, that it will be more complicated than simple.
I think for personalized medicine we have to look at how cost effective it will be. With the current state of the U.S. health care system, pharmaceutical companies might not find it profitable to make drugs target to a select number of individuals with a specific gene. I think this is ineffective and costly thing to do at this moment in time.
ReplyDeleteUsing the example of Bidil, the first drug marketed toward African Americans with Heart Disease, this is the first major drug that was considered personalized medicine. This drug was not more effective in African Americans then people of other races. Inevitably, this drug is a failure many African Americans would not buy this product for a various reasons.
Now lets expand this thought, right now we only know that some genes are associated with certain disease. An X equals Y diagnosis is never really possible because we have to take into consideration other confounding factors. The genes we do know that directly cause certain disease are called genetic disease such as cystic fibrosis and sickle cell anemia. In terms, of public health it would be more cost effective to scene the genome for genes that directly cause genetic diseases. Would we make an otherwise healthy young women with BRCA1 gene take medications all her live to prevent the development of breast cancer or ovarian cancer?
I believe that physicians are not inept enough to make decision based on the genome unless this physician is a specialist in personalized medicine. The entire workforce will have to participate in continuing education to learn what they need to know about genomics. I do not think we are ready for personalized medicine just yet.
I didn't even consider the costly nature of this. Thank you Tamika for pointing that out. I also think it would be cost ineffective and not something pharmaceutical companies would probably want to endorse at this point.
DeleteI completely agree with Caroline, that while it seems like an idea with a lot of potential, personalized genomic medicine does not seem possible at this point in time. It can already be quite difficult for physicians to explain their patients' health statuses in a way that the patients fully understand. If you factor in a genome reading, it becomes nearly impossible to explain a patient's results. Not only will doctors have to try to relay the information in the results of the tests, but they may need to elaborate on how they actually got these results. With an MRI, for example, you can show a patient physical proof of what is going on with their health that they can visualize. If someone were to see their DNA sequence, even with proper description from a professional, I think people would have a hard time relating the test results to their own health outcomes. Seeing a bunch of lines on a paper, for example, would not convince me that the doctors knew that I had a high chance of developing diabetes someday.
ReplyDeleteIn current medicine, there is a standard set of vocabulary and explanations which can be used to talk to patients about their health and make current diagnoses. The existence of a standard helps with accuracy and efficiency of the health care system. With genomics, it is all about trying to predict future disease and in order to do this I think you need to assess each person in a very individual way to give them the most accurate predictions. Doctors would need to talk about all of the possible reasons for a patients disease; this would include environmental factors, epigenetics, nutrition, etc. As Caroline said, it will take up a lot of time to give everyone the level of individual assessment and explanation necessary to truly utilize genomic medicine. It could be a good tool for medicine in the future, but as it stands right now, I think genomic medicine will lead to more inefficiencies and patient confusion than good.
Laura Alfisher
I think Caroline, and Laura in response to Caroline, have great points. Although the concept of personalized medicine could mean important advancements in the medical field, at this point, it does not seem to be feasible. First of all, it is too expensive to get your genome sequenced, $4,000 is still too expensive, and it is not yet covered by health insurance. Also, the fact that some could have their genome sequenced and others cannot due to price gives those who have money an unfair advantage.
ReplyDeleteIn addition, having your genome sequenced for personalized medicine does not mean that if you have a gene for something (either a SNP or mutation) necessarily means that this something will show itself during that person's lifetime. Confounding factors, whether it is internal or environmental, have a huge influence on whether or not the gene is turned on or off. Learning about the propencity for that gene to be expressed would be a lot more helpful for the process of genome sequencing.
Finally, I do not believe that many doctors are qualified today to read this genome sequence and give patients an accurate portrayal of what the sequencing means. There is no need to give patients anxiety about having a gene for something unless it looks as though they are going to have it expressed during their lifetime, and at this point, we do not have the technology or the foresight to determine whether that is going to happen.
Here is an article that discusses newer means of sequencing genomes that could increase the speed and lower the costs of sequencing genomes:
http://www.scientificcomputing.com/Next-Generation-Sequencing-Speeds-Personalized-Medicine.aspx
Even though we have these emerging technologies, I still believe that doctors will need extensive training on how to read these sequences as well as more information about the rates at which these genes are turned on and off in order to truly understand the human genome. Doctors need to conference about what percentage of patients that have a gene will actually express this gene. If the percentage is low, doctors should make it known to their patients that their likelihood is slim of getting the disease and vice versa. Also, since we know that environment plays a big role in gene expression, we need to look at different regions and how genes are expressed in these regions. There is so much more to understand, and unless we get a better grasp on the genome sequencing process, we should not make it available to patients.
-Dana Hindman
Also, the whole concept of X=Y for diagnosing anything, especially when it comes to genes and their expression, is not possible. Like I have previously stated, a diagnosis can only be made once these genes are expressed and that could mean that solely a sequencing of the person having a gene or not would not tell doctors much.
DeleteI definitely agree with Dana's points on the chance of the condition actually appearing during a person's lifetime. Specifically, I think her point on environmental factors can be directly related to our last post about alcoholism. In many cases, nurture can override nature regardless of a genetic irregularity. For example, a person's diet and frequency of exercise can play a huge role in developing chronic diseases.
DeleteI also wanted to touch on Dana's point of physicians being unqualified to handle or evaluate certain genetic information. I believe that this raises moral and ethical issues especially in regards to informing the patient about the results. Without knowing the certainty of developing a disease, an unqualified doctor is completely at risk of mishandling the situation. By doing so, the doctor can cause undue stress to the patient both emotionally and financially.
I also don't think we are quite ready for personalized genomic medicine. Although the progress that the field is making is exciting and the potential benefits that will result from further expansion in the field are numerous - there is still work to be done. Genomic innovations will have a new perspective and ability to help; but, will also carry a new power to harm. Before personalized genomic medicine becomes a standard part of patient care for the public and effects large numbers of individuals, there needs to be a rigorous evaluation or services and information sciences can provide. As with other scientific advancements, personalized genomic medicine will present new challenges. Scientists, epidemiologists, and health care providers will be supplied with an enormous quantity of new information and we must first make sure that the correct people to distribute the information can effective interpret and inform.
ReplyDeleteAs an article in Nature by Muin J. Khoury, James Evans, & Wylie Burke states, "Whole-genome sequencing will produce abnormal results in all who are tested: everyone will have positive results, false positives, and false negatives. Some results may prove harmful; some will be useless. Preserving the health benefits of genomics while minimizing the harms will be an important research goal." This factors in the idea that there are other determining factors for disease aside from an individual's genetic makeup (as stated by classmates above). This also highlights the necessity of rigorous evaluation before this practice is brought, affordably, to the general public.
On the other hand, this information will be invaluable for some patients and the challenging road ahead to transfer this information into common practice is exciting. Thinking about the significance of the information that could be drawn from individuals' genomes should not be outweighed by the fear of potential harms. I think in the near future, we will be ready for effective
It could be overwhelming for physicians to be responsible for this information, who are already constrained by time - and maybe they are not the appropriate health care providers to present this information to patients. Specific training and education will be required for the individuals who provide the client with the correct information and appropriate amounts of counseling and follow up will be required after a patient is informed. I think the time commitment corresponding with personalized genetic medicine will determine which health care providers are most suited to deliver the information efficiently.
I agree completely with Tamika that we should focus public health efforts on medicine for genetic variants specifically linked to disease. However, genetic information could be used to improve prevention, maybe by requiring more frequent testing for at risk patients.
ReplyDeleteI agree with Laura and Caroline that personalized medicine does not seem very likely at this point in time, especially considering the cost. This is partly because we are just starting to understand how the genome works and which SNPs and other polymorphisms are associated with disease. Also, EHRs and other ways of communicating genomic information to doctors is still way behind what it needs to be to have an effective loop between research and a clinical setting, as they described in the video. However, that does not mean personalized medicine is unimportant. As they mentioned in the video, genomics is already beginning to permeate everyday life in medicine, with personalized sequencing companies, etc. If we do not develop effective ways of conveying genomic information to physicians now, it will not be ready when it is necessary. Considering the rapid pace of technology and the existence of private direct-to-consumer sequencing available now, physicians must be increasily able to understand and apply genetic information to their diagnoses and recommendations when patients come in with concerns over variants in their genome. Also, physicians have a very solid foundation in the medical sciences and adding knowledge regarding genetic variants is far from impossible. Moreover, physicians are accustomed to explaining very complex and confusing diagnostic information to patients who may have absolutely no medical education. As such, adding genomic variation to current practices could be manageable and thus personalized medicine may be somewhat inevitable.
While an X=Y diagnosis is difficult based on the number of confounding factors, it is not impossible to improve accuracy. As associations between polymorphisms and disease become more widespread, genetic links to disease will become clearer. Also, epigenetic variation is not random, it is based on variances in the genome (e.g. changes in the sequence for DNA methylation) and on environmental factors. It could be possible, given enough information about the different environmental and genetic conditions of a patient, to use statistical models to approximate the risk a patient faces for a particular disease.
I think it's important that you bring up that although it is difficult to come up with an X = Y diagnosis, improving accuracy is definitely true/a possibility. I never thought about it from that angle. Who knows to what level of accuracy we'll attain and where that can take us in the future.
DeleteI agree with the previous posts that personalized medicine seems like a good idea on paper but when thinking about its implementation and how effective its use would be currently it doesn't seem that likely. As Tamika stated in our current society we have to think about how cost effective it would be. Is it really worth it to administer medicine based on a small population rather than targeting those genes that directly lead to genetic disorders or diseases.
ReplyDeleteAlso, I don't think that physicians are knowledgable enough in the field of genomics to diagnose their patients based on their genome and as stated in the video having a patient's genome incorporated into EHRs can overwhelm the physician which in turn would overwhelm the patient. I do think that personalized medicine has a lot of potential but physicians need to know more about the topic in order for it to be effective.
The fact that there are so many factors that influence a persons genome makes it entirely too difficult to determine genetic diseases or disorders based solely on a persons genome. As the article stated researchers need to figure out how to get from DNA to root cause and finally to a physician administering the appropriate care to a patient. Although this is an idealistic form of health care it just seems as though a lot more needs to be done before this can be realistic. However far fetched personalized medicine seems I look forward to seeing how it is implemented in the future.
Kristen's points are all very true, as are the points of everyone else. But just imagine what possibilities the future may hold! To be able to sequence a human's genome under $1,000 and provide the patient with important (and potentially frightening--but that's another story) information about their future health is an incredible prospect of the future of health care. But again, how feasible is this? I think the best way would be to begin training doctors more in the genetic field, but to do that requires an enormous amount of change in the medical curricula which people never really take too kindly. Or what about having doctors and geneticists team up? Both fields could provide different and invaluable perspectives on the process and best methods for disease diagnosis. But as mentioned in the previous comments, should we as a country be allocating this many resources to focus on personalized genomic medicine? Are there "heavier" issues, such as the state of the U.S. health care, that should be addressed before we begin participating in projects that may potentially fail? Do modern scientists have the ability to achieve such a feat or is it a lost cause? Difficult questions to answer!
DeleteI think Kristen's point about the lack of knowledge among physicians is an important one. Not only may doctors feel uncomfortable with the sheer volume of new information (the study of that alone is a full-time job!) but a doctor with only a little information could actually be harmful to the patient. We've all heard the phrase "just enough knowledge to be dangerous" - and I think it applies in this scenario. A physician who may understand the general idea of genomics but not the practical implementation may waste a lot of time, money, and energy trying to misapply genomics to their patients' care and could cause a lot of mental anguish for the patients as well.
DeleteThat said, there are already some applications of genetic therapy that have proven effective when addressing specific known genetic bases of disease. An article from the BBC [http://www.bbc.co.uk/news/health-16942795] discusses three American women with Leber's Congenital Amaurosis, an inherited disease that prevents 10 different genes from properly controlling retinal functioning. By using an engineered virus to deliver correct copies of the gene to their eyes, researchers have been able to help restore partial sight in all three patients.
While this is an exciting development, it's also important to remember that we don't understand the full consequences of altering genetic functioning in this way. Personalized genetic medicine still has a long way to go before we can confidently declare it the medicine of the future.
A few thoughts on the above comments ... I definitely understand and agree with Kristin and Yara's concerns about the knowledge and ability of doctors to interpret genetic information and implement it into tangible and beneficial treatment options in a clinical setting - especially given the limitations of our current knowledge. But after hearing from our guest speakers in lecture today, my faith in our ability to offer beneficial information and effective counseling to patients in clinical situations was really renewed. From what we heard today in lecture, I really felt like there are options for patients to receive appropriate counseling based on the best available information, and that is encouraging! Although our speakers were specialists in the field of genetic counseling, I really feel that with the right training and expertise, doctors could be trained to become a valuable resources and educators in the field of genetic counseling. As technology and our understanding of genetics continues to advance, I anticipate that it will become increasingly relevant for health care providers to be trained in genetic counseling, and I feel that this natural trajectory of development would lead us to a place where doctors are capable of delivering appropriate advice based on the best information available. Perhaps this is overly optimistic, but I really think that with genetics being at the forefront of new technology, this field is really breaking into something new and exciting where we have the potential to be able to pinpoint disease etiology based on genetic makeup - And it would be a shame if we impeded that potential simply because we fear that doctors are incapable of adapting to the challenges. This is not to say that the challenges to implementing an effective system of personalized genetic medicine would not be significant - I am sure there would be many barriers as previous posters have pointed out . But if we could really use genetic information in a personalized medical context in this way, it would revolutionize the way we understand medicine and the way we care for patients in a really fundamental way - and that certainly holds a lot of appeal and promise for the future.
DeleteSecondly, I really think Yara's comments about where we are putting our time and resources is quite on-point. Despite my optimism about the great promise that personalized genetic medicine holds, I too have reservations about investing in such an expensive and uncertain field while we are still struggling with the exorbitantly high costs of health care and a lack of access to basic health services for many Americans. Perhaps before we invest extensively in implementing new genetic technologies in our heavily burdened health care system, we should first focus on addressing cost and access issues that limit the delivery of health care services far more necessary and basic than genetic medicine. But these are tough issues to address and difficult things to balance. We don't want to halt scientific discovery and progress, but perhaps we have more pressing issues at hand in the current health care crisis.
Similar to some of the other posts, I also don't think we are quite ready for personalized genomic medicine. Although the progress that the field is making is exciting and the potential benefits that will result from further expansion in the field are numerous - there is still work to be done. Genomic innovations will have a new perspective and ability to help; but, will also carry a new power to harm. Before personalized genomic medicine becomes a standard part of patient care for the public and effects large numbers of individuals, there needs to be a rigorous evaluation of services and information scientists can provide. As with other scientific advancements, personalized genomic medicine will present new challenges. Scientists, epidemiologists, and health care providers will be supplied with an enormous quantity of new information and we must first make sure that the correct people to distribute the information can effectively interpret and inform patients.
ReplyDeleteAs an article in Nature by Muin J. Khoury, James Evans, & Wylie Burke states, "Whole-genome sequencing will produce abnormal results in all who are tested: everyone will have positive results, false positives, and false negatives. Some results may prove harmful; some will be useless. Preserving the health benefits of genomics while minimizing the harms will be an important research goal." This factors in the idea that there are other determining factors for disease aside from an individual's genetic makeup (as stated by classmates above). This also highlights the necessity of rigorous evaluation before this practice is brought, affordably, to the general public.
On the other hand, this information will be invaluable for some patients and the challenging road ahead to transfer this information into common practice is exciting. Thinking about the significance of the information that could be drawn from individuals' genomes should not be outweighed by the fear of potential harms. I think in the near future, we will be ready and have services in place to effectively use genetic information for it’s benefits
It could be overwhelming for physicians, who are already constrained by time - and maybe they are not the appropriate health care providers to present this information to patients. Personalized genomic medicine will require specific training and education as well as numerous hours of counseling for patients to deal with the information presented to them.
I completely agree that personalized medicine has good intentions and is not only extremely fascinating and intriguing but also very challenging. Like Caroline said there are way too many confounding factors to take into consideration. Because environment, variation, and epigenetics all take part in one's genome, it is impossible to simply use a SNP or an insertion/deletion to explain what each patient has the gene for, what the treatment is, or what the prevention is. You can’t control for environment and if we try to I think it will just drive people crazy. Everyone will constantly be wondering if there next decision or their next act will alter the doctor’s diagnosis and thus their prognosis.
ReplyDeleteCaroline also brings up a good point that it will take way too much time. Time is precious especially in healthcare and if we incorporate gene sequencing and giving patients detailed reports about their risks for every single possible disease…. it wouldn’t work. We would be taking time away from people who are actually sick and who need immediate attention. As Laura said it can already be quite difficult for physicians to explain their patients' health statuses in a way that the patients fully comprehend and this might make it even harder. Not to mean that patients don’t have the intelligence to understand complex things but just that I feel that this would affect the patient in a negative way. It would make the patient more paranoid and worried. The list of things the doctor would probably give the patient of things to eat, not to eat, do, not to do, vitamins to take…etc. would be endless. And as Caroline said, it will take up a lot of time to give everyone the level of intense individual evaluation and clarification needed to truly utilize genomic medicine. And I do agree with Tamika and Sami that our time and money would be better spent on efforts focused on genetic variants specifically linked to disease. I think this will target more people in general than the individualized personal medicine approach.
Dana also brings up a good point about the unfair advantage of who can afford to get their genome sequenced. What about the people who afterward can’t afford to go to the doctor regularly once they have had their genome sequence? That would be a serious issue and would lead to some risks getting undiagnosed because those people couldn’t get their genome sequenced.
Tamika brings up a really good point about how pharmaceutical companies will most likely not be supportive of this initiative. They make money by generalizing certain treatments and pills and having to make really specific pills based off certain environments and variations will narrow their patient pool. And with all the different possibilities I think there would be too many pills to keep track of and too many people guessing which pill suits them the best. It would also be extremely costly and in my opinion ineffective. With environment, epigenetics, and variation and their ability to create different outcomes from the same genes, there are too many intricacies and details of each individual’s genome to ever form a strict translation and to inform patients on their health risks.
As a result an X equals Y diagnoses is never really possible with so many confounding factors. In addition, just because a genome is sequenced for the purpose of personalized medicine it does not necessarily mean that the mutation or SNP will have an effect whether that be positive or negative. Confounding factors, such as the environmental, have a heavy influence on the actions or lack of action of genes.
However I do appreciate Sami’s slightly more optimistic response to the possibility of an X equals Y prognosis. I still believe that it is impossible to get to that point but I do agree that we can improve the accuracy.
Moreover, physicians are not inept enough to be the ones making decisions based on genomes. I feel like in order to learn all the information necessary about the genome medical schools would have to add on another year. And with all the changing information in the world, doctors would have to go back to school yearly if not monthly to keep with all the new variations and different environment aspects that must be taken into account when understanding the risks a patients may have to becoming ill. And as Amanda mentioned all this new and complicated knowledge/information could be overwhelming for physicians who have extreme time constraints. This wouldn’t be effective for the doctor or the patient. Personalized genomic medicine will definitely require specific detailed training. Maybe this needs to be a completely separate specialization.
ReplyDeleteLastly personalized medicine is impossible but impossible in a good way. I do think that attempting to solve and research toward an impossible goal will help us to create something completely extraordinary. Like the article said scientific competitions and challenging the impossible can draw out innovation from the most unexpected places.
I agree with you Kristely, this field of medicine should be considered another specialty. With the shortage in primary care physicians, let's concentrate our efforts where it is needed the most. Personalized medicine is not the field that we should concentrate an enormous amount of energy to.
DeleteYes, Tamika, yes! I really think that there needs to be some sort of organization within the United States health care system that basically lists the priorities and most "dire" topics and THOSE should be addressed first! The idea of personalized genomic medicine is incredible...but let's focus on giving everyone their basic needs first! Primary care, food, shelter!
DeleteRight on! I completely agree. Because our health care system is organized in a corporate structure of business-like hospitals and for-profit drug and insurance companies, we have no shortage of cutting edge medical technologies and expensive treatments and services. We lead the world in tertiary care services - and that is great! But we lack basic services in primary care and many Americans do not have access to minimal standards of medical treatment. It would be tough to reconfigure the incentives in our health care system to reenergize the primary care sector and expand health care access more broadly without deeper reform efforts and/or a breakdown of the current corporate structure of health care delivery. But until that happens, there is no way to redirect the resources away from expensive specialty services likes personalized genomic medicine and towards basic primary care services because businesses and money-making stakeholders push for innovation, not universal health care access. But all the same, I think Tamika and Yara's idea is right on - how can we offer people the opportunity to have their genome sequenced or to have their medical treatment be personalized based on a genetic profile while there are still thousands of people who can't even access the most basic health care services? Something about that just doesn't seem right ...
DeleteI agree with all of the barriers for personalized genomics informed medicine stated above, but I believe that the most important barrier to this type of treatment is the cost. As Tamika said, this type of procedure is not cost effective, and more importantly it will cost patients a lot of money out of pocket. Won’t this type of genomic treatment or prevention cause more health inequalities than there already are in the United States? Knowing how expensive this can be and that only certain doctors may be trained and educated in genetic testing and sequencing, won’t the upper class benefit, while the rest of the population suffers? Only the best doctors and hospitals would be equipped with the resources to provide genetic screening and personalized genome sequencing, which would mean that only those who can afford these doctors would benefit from it. Maybe someday this will be accessible for all, but as of right now I do not think that this is plausible and/or ethical. This type of personalized medicine will only extend the health gap further between different socioeconomic classes.
ReplyDeleteI definitely agree with you, Hannah. Not only will insurance companies not cover the costs, but the cost of the procedure is too high for the majority of the population to have their genome sequenced. In addition, the upper class citizens who would be able to afford the procedure would most likely have better health care in the first place and would not necessarily benefit as much from it as other citizens might. There is also the possibility that if a lower class person was to save enough money to pay for the sequencing, there is a possibility that the results could show that the person tested positive for a certain gene that will call for medical attention and high usage of their health insurance. In the insurance company's interest, they would then have cause to drop coverage, which will leave the person with a positive test result in their record, and without proper health care to tend to the problem. This is one of many ethical issues that arises from genetic testing such as this. As of now, there are too many financial and ethical obstacles to overcome so as to make this a reality.
Delete-Rachel O'Canas
Personalized genomics needs to be looked at in ways such as how much it costs, how long it will take, and how realistic it is. Although, the fact that personalized genomics has come into consideration does open up more opportunity to find more ways and information on how genes work with the environment. But, when discovering correlations with the environment and genes can cause a lot of ruckus with people avoiding things when they know that certain things in the environment will bring forth disease.
ReplyDeleteAside from this, I agree with many of you in the forum in how this procedure is not cost effective. The last thing that is needed is to be spending more out of pocket money. There will need to be a lot of money for all the procedures mentioned to know what and why the environment causes the genes to react. Only a few higher socioeconomic classes will be able to afford this personalized medicine.
In an ideal universe, personalized medicine for every single individual would be the standard. There would never be a lack in educational and scientific funding, everyone would be entitled to health care, and technology would be sufficient for identifying and screening every gene-related disorder known to mankind.
ReplyDeleteNow take a quantum leap backward.
Currently, over 40 million Americans lack health insurance. Many million more hesitate to get treatment for injuries, chronic disease, and life-threatening illnesses because they cannot afford it. Individuals continue to be discriminated against in our system of health care provision. While the technological advances in medical research have been great (as illustrated by the HGP and GWAS), the social advances in delivery and care have been nonexistent.
In this country, and in most areas of the world, medical care is a resource, not a right. It is limited to those who have the ability to afford it. It is limited to those who have a government that advocates for it. Therefore, a tradeoff exists. With the introduction of personalized medicine, providers, educators, and researchers will inevitably distribute their resources to the field that is given the most interest and funding. We see this with the introduction of personalized medicine divisions in some medical schools. It is unquestionable that those who are able to afford personalized care will be the first to receive it. And physicians who specialize in this area will make immediate and enormous profit, as opposed to physicians who are reimbursed by Medicare and Medicaid.
I predict a paradigm shift in the type of medical care given, but fewer individuals will have access. Those who are swept aside in the current system will continue to struggle unless progressive social policies are able to follow suit.
Great post Suzann. Very true. In the current state of our health care system, health care is not a right and many services continue to be limited to those who can afford them. Recent health care reform efforts have done little to ameliorate these concerns and health care costs continue to rise, leaving thousands without access to care or without the ability to pay for it. Unless health care reform really takes an aggressive step forward to address some of the issues with health, equity and access, genetic testing and personalized genetic medicine will be just like many other health care services - available only to those who can pay.
DeleteHowever, in thinking about this, I wonder what genetic technology and personalized medicine would look like in another country like England or Germany where the health care model differs greatly from our own here in the U.S. Clearly there would be potentially prohibitive cost concerns associated with utilizing such expensive technologies given the budget-strapped nature of universal health care systems in many European countries, but having a single-payer government-run health care system would really put everyone on a relatively level playing field in terms of accessing personalized genetic information. How does that change the equation? Does it become more appealing or ethical if the information can be utilized in a more equitable fashion? If so, would we be less skeptical and more willing to invest in this new technology? Changing this part of the equation certainly doesn't fix all of the aforementioned concerns, and it might not even be a realistic assertion to consider at the current moment, but I think it is an interesting question all the same.
I agree with previous posts that state that although personalized medicine has much potential in the medical field at the moment it is still costly, nevertheless it is an idea that is not completely feasible.There are several possibilities that can be considered when looking at the field of personalized medicine. After all when you consider medicine itself, every progress has started as a discovery which has progressed to the point where it becomes personalized.
ReplyDeleteWhen considering Human Genome Sequencing, we already have the tools needed to read the human genome, and although discoveries are still being made and the cost remains high, the first essential step has already been achieved. In order to make Human Genome more personalized for primary care use. Databases, formulas, and Labs can be created.
What we can do is in order to begin this process is to have DNA samples sent to laboratories that specialize in Human Genome Sequencing so that these laboratories can analyze the DNA, and make an analyzes. Once these laboratories do this they can email the doctors the result and a description of what to tell their patients. This is essentially already done today with blood exams, were the blood samples are sent to local laboratories (if the proper equipment is not available) and clinics receive the results. The reason why we must consider exporting the analyzes of Genome Sequencing is because it would require much training and a high cost to properly train hospital and clinical staff to learn how to analyze and interpret results without considering the cost of the equipment needed. Therefore if we are to consider the idea of personalizing human genome sequencing we would have to send the sample to laboratories, not only because of the cost, but also because as previously stated not every human genome fits the mold, and what applies to one may not apply to all.
One way that genome sequencing can become more personalized is if databases where created with all results, so that once it becomes less expensive clinics and hospitals can purchase the equipment needed to analyze genome samples. Using databases the laboratory technicians at hospitals can enter the genome data into these databases and receive the results for each persons genome and send an email to the doctor with the results. In order to make this happen this must be done with a small survey sample and make it more available to areas as the database grows.
These are all possible solutions to human genome sequencing analyzes, but as you can see the possibility of a physician being able to do all of this himself and decimate the results to a patients is far from achievable if it is at all. But I do believe that if the samples are analyzed by another person and the results are sent to a physician so that he may relay the message, and this is mostly based because there is no simple formula that gives you results because every genome has the possibility to be unique,that is more feasible. Simply because this is what is done at the moment with all medical exams, doctors receive the results in a simple paragraph and if they choose they can see the actual data or images. In order to do this much progress must be made in the field to make this less expensive and more achievable.
I agree with many of the previous posts that highlight both the added costs as well as the potential harms of the rapid growth of personalized genomic sequencing. I feel that right now, the incredible advances being made in technology must be put into perspective. While genetic sequencing can have potentially wonderful results in the future, if the practice develops more quickly than we can process it properly, negative outcomes could also occur. It's easy to see genetics as concrete and unchangeable while in reality it can be altered by any number of factors, making the "predictions" from a genetic sequencing more of a hypothesis than a diagnosis. Also, as mentioned in previous posts, doctors and other healthcare professionals are not currently trained or equipped to fully analyze and describe the genetic sequences to their patients; therefore, the training of these providers will incur additional costs as well.
ReplyDeleteThis being said, I think the project being conducted the the Children's Hospital Boston to see who can put together a "readable" document that doctors can use to present to their patients is an excellent step in the right direction. This project focuses on making all this new information actually understandable to both providers and patients and thus empowering people to better understand themselves. While there is always the potential for unintended harms: the stress of knowing one's genetic disease markers, the unequal ability for some patients to afford genetic sequencing while others cannot, etc., there are also some great potential benefits to the thoughtful and practical integration of genetic sequencing into general medicine. The article discussing the importance of family histories also mentioned the positive combination of traditional doctor practices, such as obtaining relevant family histories with the newer innovations such as genetic sequencing.
It seems to me that the key in practically applying genetic sequencing to general medical practice is to let the process occur gradually. Genetic sequencing should in no way replace important medical practices such as obtaining family histories or discussing environmental risk factors with clients. Instead, it should be integrated into this system as yet another tool that could eventually allow patients to better understand themselves and their health.
The field of medicine continues to bring about sophisticated advancements that have potential to significantly enhance/better the health of many. However, as the majority of people have already mentioned, the factors of cost, time, and threatened health care equity, restrain these medical advancements from being utilized in our society. While the idea of personalized medicine is intriguing and offers hope of improved health, we have to look at the bigger picture, and realize that this type of medical breakthrough is not the one our society needs right now to solve our issues of health care. While personalized medicine is not appropriate at this point in our time, I believe it does have potential to be very useful and necessary in the future.
ReplyDeleteI believe personalized medicine, while it has the potential to be extremely helpful, may not be what society needs at the moment. The US has enough problems trying to make quality healthcare affordable to everyone, personalized medicine will only continue to increase the gap already prominent in the US.
ReplyDeleteAlso, while focusing on prevention is extremely important, if people do not have the specific gene that puts them at risk for a disease, will they feel invincible and not have a healthy lifestyle? Which in turn may significantly increase their risk of developing a disease. There are enough health problems in the US, including access to healthcare, a shortage of primary care physicians and epidemics of obesity, heart disease and other illnesses, that deserve our attention.
Lastly, I'm not sure if people would be prepared to know whether they are significantly more likely to get a disease in their future. I know I would not want to live every day knowing such drastic information. Instead, we should focus our efforts on quality healthcare and focus on prevention.
I agree, personalized medicine is where research is heading, but socially we're not there yet. Our health care system keeps pushing 'new' technologies aimed to improve our knowledge about our physical selves...and then what? What does it matter that I suddenly know I'm most likely going to have cervical cancer in the future if I know I'll never be able to afford the treatment for it? Futhermore, I don't understand how personalized medicine fits in with public health? If medicine is to be so individualized, how and what can medicine generalize as trends to look out for?
DeleteIn my Race, Society, and Medicine class (SO355), we watched a movie called Gattaca in which everyone was identified solely by their physical/genetic markers...blood, hair, nails, saliva, etc. The goal was to create a more equal society in which everyone was evaluated the same way regardless of family status, skin color, whatever else...But stratification still occurred among people and new categories emerged in which "healthier" people were given the best paying jobs, sought after as mates, and held as naturally superior beings. What does it mean to say we're trying to 'personalize medicine'? Isn't medicine personalized already? Are we referring to personalization as the opposite of basing medical evaluations on observed population trends/risk factors? If so, we're back at the nurture vs. nature argument. Neither is absolute, so pushing for a genetically based personalized medical system is ignoring too much of the epigenetic influences we know affect our health greatly.
Allison Manfreda
ReplyDeleteSimilar to Caroline and many other students, I think that the idea of personalizing medicine could be extremely useful in the future, however, at the present it does not seem feasible. As Dana mentioned, it is still extremely expensive to have a person’s genome sequenced, and it is not covered by medical insurance, making it extremely difficult for the general population to afford or have access to. As the prices of genome sequencing continue to decrease the practice may become more available to the general population, but that is not the situation at this time.
I believe that some type of personalized medicine through the understanding of genomics may become available but it is difficult at this time to say what type of program and the extent/depth that it will cover. The genome is so complex that it will obviously be extremely difficult to gain enough of an understanding of each individual to create a personalized form of medical practice for each individual, however it is a noble and exciting goal for the future. I think that the various disciplines associated with genomics such as epigenetics and nutrigenomics are fascinating and will have significant impacts on billions of lives if they are to be further developed and understood by clinicians.
The idea, however, of understanding the specific intricacies and details of each individuals genome seems very far off, if it is even possible. As science advances I think we are getting closer to steadily improving the health of billions of people through the new understanding of the genome, but I am not sure whether I believe that it will ever be possible to reach that specific level of detail. As Dana and others mentioned, because there are a myriad of confounding factors, I do not believe we will ever be able to say that X equals Y for diagnoses. Furthermore, although clinicians are very skilled in a variety of areas, they are not trained geneticists and therefore I do not believe their current medical training is inept enough to be the ones making decisions based on genomes. In the future it is possible that medical school training will focus on genetic advising and that will become a large focus of study, however at the present time I think it would be unwise for doctors to be advising patients when they are not specialists, and when this is a new branch of science, which is still being developed.
When first reading about genome sequencing and all the possible improvements it could bring to the diagnosis and treatment of patients, one overlooks the exact point of this article in that although mapping of one's genome will be beneficial to their health, an understanding of this sequence by both the physician and patient is an integral piece in the utilization of this medical technology. Putting costs aside, if one opts to have their genome sequenced, the results must then be understood by the physician and patient alike to ensure that together they are making the best, most informed decision regarding the patients health with the information they have been given. Therefore I think the initiative asking companies to try to establish an easy and simple way of explaining and understanding a genome sequence is yet another very important piece to making this technology as successful and useful as possible. And even though many have stated that while this is a valiant effort, we are still not ready for personalized medicine in the present, based on what I have pointed out, I think working towards this goal is something worth spending time on.
DeleteSorry I didn't mean to reply directly to Allison's post, I meant to post my own response.
DeleteAlthough this system seems like a nice idea on the surface, and I understand the intentions of it all, I agree with Allison when she says that personalizing medicine is not very feasible. There are many factors that contribute to why I believe this. First of all, as many of my peer have mentioned above, the costs of this new system would be extremely high. It would not only be costly to train physicians how to analyze and describe the genetic sequences, but it would also be very costly for patients to simply attain this information. In addition, healthcare and health insurance costs are already at its highest right now that this new system would just be another added cost that 16 million Americans are unable to even afford. Therefore, this will cause an even greater inequality among the population in our healthcare system and it would be unfair to those who can't afford these services. Not only will the inequality increase, but discrimination will as well. Health insurance companies, whether some may like to believe it or not, are already judging humans based on their health status and history in order to determine whether they are worth insuring or not--all based on risk. So if all of this specific information on a human's genome is released, will insurance even cover personalized medicine based on what they know in a person's genome?
ReplyDeleteOn another note, now that I am beginning to understand how environment, epigenetics, and variation create different outcomes from the same genes, having someone's genome sequenced for personalized medicine wouldn't necessarily solve the problem. Mutations and polymorphisms are happening all the time, and from what I've learned in class, just because you have a gene for a certain disease, does not mean that it will be expressed during someone's lifetime. Just like Dana mentioned, confounding factors have a big influence on whether or not a certain gene is turned on or off. Also, the intricacies and details of each person's genome will be very difficult to explain to a patient. Not only will it be difficult for someone to completely understand, but it wouldn't be fair to inform someone about a disease that they may never even have in their lifetime. It will only add more stress and anxiety to that person.
An X equals Y diagnoses is not possible with so many confounding factors. Confounding factors, such as the environment and personal behavior, have a huge effect on whether or not the gene is expressed or not.
Correction: 46 million American are uninsured
DeleteWhen first reading about genome sequencing and all the possible improvements it could bring to the diagnosis and treatment of patients, one overlooks the exact point of this article in that although mapping of one's genome will be beneficial to their health, an understanding of this sequence by both the physician and patient is an integral piece in the utilization of this medical technology. Putting costs aside, if one opts to have their genome sequenced, the results must then be understood by the physician and patient alike to ensure that together they are making the best, most informed decision regarding the patients health with the information they have been given. Therefore I think the initiative asking companies to try to establish an easy and simple way of explaining and understanding a genome sequence is yet another very important piece to making this technology as successful and useful as possible. And even though many have stated that while this is a valiant effort, we are still not ready for personalized medicine in the present, based on what I have pointed out, I think working towards this goal is something worth spending time on.
ReplyDeleteI believe that using genomics and genes in order to better diagnose patients is where the future of medicine and health care will eventually lead, however I don’t necessary think it will happen soon as there are still many conflicting factors such as integration with an already complex health care system and being able to learn and teach practicing physicians to use this new science to treat their patients.
ReplyDeleteA point that that Rex Chisholm presents in the video is that there is even more information to consider during physician – patient consultations for the physician. With such little time during check ups and other health factors such as environmental factors, social factors, mental, to make physicians have to worry about genomic factors during such a short check up would be a great burden on their initial diagnosis. To me a solution would be to subsidize the primary care physicians to be able to look at genetic variants and be able to take action based on them. Subsidizing would give incentives to create innovation to focus on genomics and integrating it in a clinical setting.
Education is also another factor. With a new generation of physicians and doctors would have to be the guinea pigs of this new idea. How much time and devotion can medical schools compromises for this new field and to make this primary care, not a specialty. Active research, constantly there are more discoveries and evidence behind genomics. Being able to take this information and use it fluidly within physician-patient interaction is a hurdle that we must come across. Again, subsidizing from the government is crucial towards this goal as inspiring doctors and physicians would have more incentive to learn about genomics and go into the field.
But assuming that government subsidizing is not an issue, it would be very difficult to change a health care system aimed to serve a population and change it to serve the individual. Like all medicine it can be extremely helpful to an individual, but it may be expensive and useless to another. So to answer that if an X equals Y diagnoses will ever become possible with so many confounding factors, I believe it would be, however it would take a long period of time and governmental discussion about policy in order to use it efficiently. If genomics is used in a clinical setting, then physicians would be able to make decisions based on genomes through a new integrated system where genomics and gene study is more involved with clinical care.
As this is about the 30th comment, I will try to avoid overkilling what has already been said. The previous posts are thoughtful and I agree with the majority them. I do not think that an X=Y diagnosis is currently feasible for the many factors listed above (environmental confounders, financial barriers, lack of EHRs, etc). Current attempts to make this X to Y diagnosis would take a significant amount of resources, including time and money. I also think integrating personalized genome medicine will take serious planning and training. Although doctors are very intelligent, the majority of them are not genomics experts. In order for personalized medicine to slide into routine clinical care, doctors will need to learn how to understand the full genome sequence and how to effectively communicate information with their patients. I also think there needs to be standardization among physicians on how to present this information. Electronic and universal medical records will aid this step. Undermining or overplaying the importance of genetic sequences has consequences for patients. I think someday a high level of accuracy (although not perfect) will be attained through personalized medicine and diagnosis.
ReplyDeleteI think Nina brings up a good point that there needs to be standardization among physicians on how to present this information. But I think this will take a very long time because even though it may be presented in a standard way it doesn't mean that the patients will interpreted the way the physicians would like them to.
ReplyDeleteI agree with Nina and so I choose to take a different approach to this topic. Imagine if this personal genomic medicine is already here and fully functional. I as the patient would personally want to be able to read my genome my self as well because I feel it would be easy to misread. Would then a new branch of doctors begin to appear that if you had a genetic "problem" one would go to a genetic orthopedic doctor and if they where in a car accident then they would go to a regular orthopedic doctor. I see that these doctors will be extreamly versed in reading the genome. I think that this personalized medicine is just another level to get better care but also for the pharmacological company to get more money. Though if we start probing at our genome to much with genetic therapy could we end up damaging it? produce humans that have less diseases ( genetic)? I think its been said before that we have this plethora of knowledge from our genome but many problem do not have a solution yet ( which was hit upon whether or not you would want to know what genetic problems you have).
ReplyDeleteIn agreeing with Kristely, I believe that genomics will become its own specialty in the medical field. Currently, physicians are not properly trained to fully assess human genomes and then further evaluate their patients’ health risks associated with the genome. In today’s medical schools there is an increased focus on genomics compared to past generations but physicians are still not highly trained in the field and therefore are not qualified to read and assess genomes. Either the medical school process must be altered to include more genomics or genetic counselors must be trained and used specifically for the purpose of reading genomes and assessing and counseling individual and familial risk.
ReplyDeleteI believe there will never be an X equals Y diagnosis because there will always be a multitude of confounding factors. Environment and individual behavior play a major role in an individual’s health and therefore simply because someone has the gene for a disease does not mean they are going to get that disease. Also, simply “getting” a disease or condition does not mean the disease is a major threat to the individual.
As for whether a system of personalized medicine in genomics is possible, I think we will never fully achieve a complete personalized system, we will become close. Because there are so many confounding factors to health, there will never be a system where if a person has a certain genetic variation or polymorphism then they will have illness “X” and they will receive treatment “Y.” However, I do believe with more knowledge about genomes, physicians can personalize prevention, diagnosis, and treatment plans to ultimately improve the health of their patients.
Although genomics is becoming a popular tool to treat and prevent diseases, it is still a complicated field that needs expert specialists. I do not think primary care physicians or specialty medical doctors are qualified to present to patients the results of the patients' genetic tests. The results of genetic tests do not always give a clear X=Y diagnoses, which doctors are used to delivering. Instead, the tests may give the patient their risk of acquiring or passing on the trait for the disease. I will admit that I do not know the exact curriculum of medical school, but I think doctors are trained to rule out disease diagnoses based on the presented symptoms of the patient. Doctors are not trained in genomic testing. They work with human bodies as a whole rather than focusing on the individual's genome. I think if physicians were to work as a team with genomics experts, they would be able to make clearer diagnoses and also be able to prevent diseases that would have been otherwise unnoticed.
ReplyDeleteI agree with Allison. Personalized genomic medicine shouldn't be incorporated in patients health when seeing their primary care physician. Although it does seem beneficial in providing more efficient health care it is still an up and coming field. Considering the high amount of In Patient care provided in hospitals incorporating genomics into an already hectic system would slow down how the doctor provides care for the patient. Personalized genomic medicine should be specialized for people who would like extra attention on how their diagnosis is provided. A system of such caliber is definitely possible but would face much difficulty due to the extensive amount of confounding factors. Genetics is so unpredictable that it hard to say if an X=Y diagnosis will ever be found but science is always changing so it is really up to the individual that is ready to take on such a difficult task to get as close to an X=Y diagnosis as possible.Right now, physicians are not inept enough to make decisions based on genomes due to confounding factors. Today, Personalized genomics medicine will only be a factor in how physicians are able to provide even better care but genomics alone may not be enough to make strict diagnosis for each individual.
ReplyDeleteI think that in the future the idea of personalized genomic medicine being incorporated in patients' health could have a positive impact on patients' health. However, I agree with Ashley that since it is still an up and coming field it will more likely cause our health care system to run even less efficiently. Once more is understood about the relationship between the human genome and disease and a system has been figured out to effectively integrate it into a primary care physician's daily practice, then personalized genomic medicine would make sense. But, I think the U.S has many other issues that need to be handled before personalized genomic medicine can even be considered. Hopefully in the future it can become a part of a physician's care.
ReplyDeleteI was surprised to hear that there are already commercials broadcasted on the issue of personalized genomic medicine. The general public can now learn about these options, and seek intervention. What interests me about this, is that even before there has been enough time to really think through the consequences of this personalized branch of medicine, individuals will be hearing more about it, therefore becoming more interested in it and seeking it out. This in turn will push the process even further along, due to media interference. I'm sure these commercials do not mention that the results of testings and screenings are not exact. The general public is not informed that it is a very complicated process that has many different components. The media is being used as a tool, to educate people on the positive aspects of personalized genomic medicine, how is additional information being provided?
ReplyDeleteFirst off, I have to say that the competition that the CLARITY promotes is pretty significant. So far, our efforts in genomics have been mainly to push the bar in speed and accuracy of genomic sequencing, and not nearly enough research has been done in how to use all of this information effectively. I am excited to see where the CLARITY project leads us, hopefully to a system that doesn't give black and white answers but rather one that gives doctors the tools they need to be able to engage in healthy conversations with their patients about the risk factors for disease presented in their genomes.
ReplyDeleteAs for personalized medicine, I think it has exciting potentials though significant limitations at the same time. I think that before we entertain the notion that pharmaceutical companies will now start making medicines tailored to one person as some of my classmates have purposed, we need to think about how a doctor may use an individuals genome to prescribe medications that already exist. As we have seen in previous blogs, doctors have been able to use genomes to see that certain individuals what benefit greatly from taking an aspirin daily, while others may benefit from being on one line of drug as compared to another. I think that in this aspect, the pharmaceutical implications of having a persons genome available are endlessly useful. Limitations of having personalized medicine though include lack of manpower and complete understanding by healthcare workers about the interpretation of human's genomes. Soon doctors will need to be trained extensively in how to use the genome as a tool in everyday clinical care. For this reason, I hope that projects like CLARITY result in systems that will aid medical professionals in the interpretation of an individuals genomic information
While genome sequencing can teach us much about our health, I think a thorough family medical history could likely tell you the major attributes you are likely to inherit from your family. So really, genome sequencing will tell us how to form precise treatment plans for a patient with a certain condition rather than inform them of new conditions to which they may be susceptible. This view is altered, however, when you start to consider epigenetic changes which may not be traced back quite as far. If insurance companies are not already taking major inheritable conditions available through family medical history into account (which I believe they are,) then knowing the minor variants in a person's genome may not affect their policy as much as we think.
ReplyDeleteWhile doctors' skill set is another challenge to overcome, it seems that rather than reteach all the doctors, we could recruit some skilled geneticist/computer scientists to create tools, such as a genetic variant database, to help put genetic information into perspective for doctors. However, creating the criteria for this database will be the real challenge for personalized medicine. How do we classify the endless combinations of variants and epigenetic factors continuously bombarding our genome?
Personalized genomic medicine is an innovating system that brings positive yet revolutionary changes in medical treatment and prevention, however, i believe it would not be feasible in the near future. Like several people has comments about the system's cost, I agree that cost is really the foremost challenge that hinders personalized genomic medicine from implementing in the current health care system. As mentioned in the genetic counseling lecture, genetic testing is very expensive, so is individual genome sequencing and would not be covered by insurance. Therefore the idea of personalized genomic medicine maybe only be limited to people who can afford the luxury. This way will only widen the gap on health care due to people's socioeconomic status. In addition, say if someone can really afford to have their genome sequence read, the genetic information is so intricate and detailed that an ordinary medical doctor may not be able to explain to the patient in the most comprehensive and explicit way to achieve the original intention. So this requires additional training of medical personnel. Investing in human resources to finish the job goes back to the question of whether the new system is cost effective. Personalized Genomic Medicine could potentially benefit in improving our health care outcome, but we have a lot of problem solving first.
ReplyDeleteI certainly think that such a system is possible but I am not sure that now would be the right time for it. With such disparities in the US healthcare system today, I think the effort would better spent in other more useful areas. While this system promises endless possibilities, as many of my peers have said, it is simply not cost-effective at the moment. It would require training doctors in how to read genetic sequences since most are not very knowledgeable in the subject of genomics. Not only would it be difficult in producing this system but it would be difficult for the general public to afford. A large number of Americans cannot afford nor have access to basic healthcare let alone personalized medicine, which is not covered by insurance. This would only widen the gap in health status that already exists. Furthermore, in the case that a certain gene is found in one’s genome, it does not necessarily mean that they will have the specific condition. And because there are many different factors that impact a person’s genome, it is difficult to determine what exactly triggers certain genes. This in itself somewhat discredits the X=Y diagnosis theory.
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