Monday, February 2, 2015

Personalized vs Precision

The NIH web site defines Precision as follows:

Precision medicine refers to the use of information about the genes, proteins, and other features of a person's cancer to diagnose or treat their particular disease.

Not at all clear how that differs from personalized. The IOM also has a report on Precision Medicine.

Over the past few years we have been examining and commenting on various approaches and schemes directed at diagnosis and prognosis based upon individual genes. Some cancers are simple, such as CML and the Philadelphia Chromosome. A simple translocation and a kinase inhibitor works, for a while.

Yet when we examine say melanoma and BRAF V600 mutations, the therapeutics work, sometimes, and just for a while. No real home runs.

Now I suspect the intent is to amass a massive data base on 1 million people and examine how they perform. Nice idea but at what cost? For example even in a simple trial the costs could easily be $10,000 per person over a simple tracking lifetime. That is $10 Billion, not the $300M suggested. That is how we get into trouble. Then the question is; track what? We can get the somatic DNA from several organs but what if they have a malignancy, say MDS. Just what are we trying to detect, we do not know now. Moreover, we know that even a simple cancer, say prostate, have multiple genetic changes, just look at the putative prognostic markers using dozens of gene expressions.

Thus the problem is that such a program has merit if it is socialized and agreed to and built up to, not jumped on full force with so many loose ends. To some degree in my opinion it is a shame that NIH and its centers are fronting such an effort while so many other opportunities need examination.