Feb 26 2019
Precision medicine is a focus of ongoing debate. In an environment of limited research funds, there are those who believe that precision medicine should be funded because it will improve population health, and those who feel that it shouldn’t, because it won’t. In a viewpoint published Jan. 28 in the Journal of Clinical Investigation, experts at Johns Hopkins call for a redefinition of precision medicine to ensure its success, and propose a new approach.
Precision medicine today is too focused on a narrow set of -omics measurements, rather than on clinically relevant data using any measurement available that advances our knowledge about patient outcomes. That focus is both too narrow and misdirected, and we need to stay with the times and widen the focus as we go.”
Antony Rosen, vice dean for research and director of Johns Hopkins inHealth, the precision medicine effort at Johns Hopkins
Despite the poor state of national health, U.S. annual health care costs approach $3.5 trillion, which just doesn’t make sense in a country that has the best medical technology and treatments in the world, asserts Rosen. The problem, he says, is that everyone is looking in the dark for the causes of human disease instead of shining available lights that patient “subgroups”—delineated by measuring clinically important differences between patients who have the same disease—bring to the problem.
“When you realize you’ve lost your keys in a dark room, where do you start looking?” asks Rosen. “Would you start looking in the dark, or would you turn on the light?” Using measurement alone to understand the cause of disease without first defining the groups of patients whose disease is more similar in terms of clinically important outcomes, says Rosen, is the equivalent of looking for your keys in the dark.
Instead, Rosen and colleague Scott Zeger argue that new data approaches to define these subgroups of patients based on important clinical outcomes—how the disease progresses over time, whether the patient develops complications and what kind, and response or lack of response to specific therapies—coupled with advances in a wide range of measurement tools including genomics, provides exceptional opportunities to reimagine clinical care. This precise and more convenient subgrouping will harness significant value for the patient, the health care system and society.
Says Rosen, since not everyone responds to every treatment, there is great value in knowing who will not respond to expensive treatments. “In addition to saving unnecessary expense treating people who will not respond, as part of Johns Hopkins inHealth, we are further studying the nonresponders will teach us more about their disease so we can develop additional treatments that might work for more people,” says Rosen.
And using new technologies to search in the light for your keys is how the promise of precision medicine will play out to improve the health of populations.