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Precision medicine: Logical outcome of modern healthcare

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There is one phrase, which is not part of the Hippocratic Oath, but everyone in medicine knows it. ‘Primum non nocere’, meaning ‘first do no harm’. Beyond the commitment to healing, this is the second most important bastion of healthcare – and the requirement at the core of precision medicine.

What are the benefits of precision medicine?
Throughout history, the practice of medicine has largely been reactive. Even today, we usually must wait until the onset of diseases and then try to treat or cure them. And because we don’t fully understand the genetic and environmental factors that cause major diseases such as cancer, Alzheimer’s and diabetes, our efforts to treat these diseases are often imprecise, unpredictable and ineffective. The drugs and treatments we devise are tested on broad populations and are prescribed using statistical averages. Consequently, they work for some patients but not for many others, due to genetic differences among the population. On average, any given prescription drug now on the market only works for half of those who take it.

Personalised medicine, because it is based on each patient’s unique genetic makeup, is beginning to overcome the limitations of traditional medicine. Increasingly it is allowing health care providers to:
1. Shift the emphasis in medicine from reaction to prevention
2. Predict susceptibility to disease
3. Improve disease detection
4. Pre-empt disease progression
5. Customise disease-prevention strategies
6. Prescribe more effective drugs
7. Prescribing drugs with minimal side effects
8. Reduce the time, cost, and failure rate of pharmaceutical clinical trials
9. Eliminate trial-and-error inefficiencies that inflate health care costs and undermine patient care

How Genetic changes in your cancer are identified? NGS (Next Generation Sequencing) role.
NGS is an innovative approach that has revolutionised genetic studies. This approach is transforming medicine by providing individual’s genetic profile that guides decisions made in regard to the prevention, diagnosis, and treatment of disease; this both maximises health benefits and minimises the risk of disease. This diagnostic and prognostic information had previously only been available in multiple analyses.

NGS parallelises the sequencing process, producing thousands or millions of sequences concurrently at high speed and low cost. NGS includes different methods such as whole genome sequencing, whole exome sequencing and targeted sequencing, transcriptomics, proteomics, epigenetics. NGS has led to an explosion of discoveries of causes of genetic diseases, new underlying pathways, and identification of novel mutations that has extensively expanded genotype-phenotype relationships. To benefit from the genomic medicine in improving patient care, clinicians need to be trained to understand the inheritance pattern of diseases, how to confirm the clinical diagnosis with genetic tests and potential novel gene based therapies. There are still many challenges ahead but looking to future, the great power of genomic techniques will allow molecular diagnosis to become a standard investigation in patient diagnosis and therapeutic interventions.

Immunotherapy for cancer:
Cancer immunotherapy specifically is intended to improve the immune system’s ability to recognise tumor cells in the body and deploy T cells and other defenders against the tumour. Chemotherapy and targeted therapy directly attack and kill cancer cells. Immunotherapy, however, is not so much aimed at cancer cells as it is at stimulating or removing restraints on the immune system, which unleashes white blood cells called T cells against the tumour. This kind of treatment has proven effective for some patients with melanoma, lymphoma, kidney cancer, and other types of cancer. Spurring the immune system against tumours can have side effects when the immune cells attack normal tissues. Research is ongoing to improve immunotherapy and make it safer for patients. Immunotherapy combinations with chemotherapy and targeted therapy being used.

Both precision medicine and immunotherapy are treatment approaches that researchers believe have a great deal of promise to transform cancer care.

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