What is the future of medicine?

Tailoring procedures and treatment for the patient is on the horizon, while public policy, managing privacy and funding research will hinge on the outcomes of this Election Day and beyond.

More effective and efficient ways to prevent, diagnose and treat medical conditions may be on the horizon.

An emerging approach known as “precision medicine” could transform health care from trial-and-error and one-size-fits-all practices to health care that’s customized to a person’s specific medical condition and unique characteristics.

“The idea is to look at each individual person and the nature of their particular disease and their unique physiology,” said Nathan Myers, a political science professor and a member of the university’s Center for Genomic Advocacy. “Medical treatments are then tailored so that they work the best with both the disease and the physiology of that particular person.”

The approach could create the kind of health care we dream about — cures for diseases like cancer, getting the right treatment the first time, fewer repeated visits to doctors, reduced negative side effects and ultimately less costly health care. 

That dream might not be too far away from becoming a reality. Some innovative technologies already exist for potential use in precision medicine, such as the gene editing tool called CRISPR that can accurately identify and replace harmful genes that cause diseases such as cancer. (A federal panel recently approved an application to use CRISPR in humans.)

But as new technologies emerge, so do new questions. The rising interdisciplinary practices in health care are bringing professionals from medicine, science, insurance, risk management and public policy to “look at not only the scientific and medical aspects, but also the broader societal implications and how to best manage new innovations to get the most out of them while minimizing the unintended negative implications,” Myers said.

While precision medicine may be the way of the future, questions about the use of genetic information, accessibility of new technologies and coverage by health insurance aren’t completely answered yet.   

“A big one is the privacy of genetic information,” Myers said. Precision medicine, especially for curing diseases like cancer, requires researchers to understand the genetic components of diseases and how they function in people. That means researchers need to collect and study genetic information from a diverse range of willing donors.

“When you talk about collecting these big biobanks full of genetic information, people become concerned about who is going to have access to it and how it is going to be used,” he said.

The initial cost of precision medicine treatments is another concern. Because existing technology and techniques are complex and new, precision medicine treatments “would be rather expensive to provide now,” Myers said. High costs may initially diminish the accessibility of precision medicine treatments, and health insurance policies have not yet begun to cover them.

It’s in these and other challenging questions where health care meets public policy.

“The search for policy solutions is going on nationwide,” Myers said. “There are many different policies in a lot of different places that could affect the long-term efficacy of precision medicine.”

Most existing federal policies intend to promote the research and development of precision medicine. The Affordable Care Act now includes a provision of $200 million for that purpose. The Precision Medicine Initiative of 2015 devotes $215 million for the same cause. This year, a bill known as the 21st Century Cures Act, which proposes changes to the regulatory process for new medical treatments as well as provides research funding, has been in the works in Congress.

“I think the big thing, politically, is finding the balance between government acting as a partner of the biotech industry while at the same time making sure that it is instituting adequate protections so that people are not harmed either when participating in research or receiving treatment,” he said.

Public policies, especially those that fund critical scientific research, will play a role in advancing and shaping precision medicine. With the upcoming election of a new president and members of Congress, the nature of that future is difficult to predict.

“The big question is how much is precision medicine a priority,” Myers said. “If it came down to scientific research versus other public policy priorities, where would scientific research fall …. There’s been a lot of talk about the potential, but the question now is how much of that potential is going to be realized and when.”

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