Nov 9, 2011 - Health + Traits

The Power of Predictive Care

You are unique, but sometimes, when you see your doctor, you don’t feel you’re being treated that way.

The promise of personalized medicine is that what makes you, you can also be used to tailor the health care plan that is most effective for you.

A photo of Dr. Ralph Synderman

Dr. Ralph Snyderman

Dr. Ralph Snyderman This is already happening partly because of the work of people like Dr. Ralph Snyderman, chancellor emeritus at Duke University, and  James B. Duke, Professor of Medicine. Snyderman will speak early next year at the Personalized Medicine World Conference 2012 about bringing this approach into the clinic.

“As far as I’m concerned, the patient must be at the center of effective personalized medicine and prospective care,” he said.

Prospective Health Care

The former Dean of Duke’s medical school and Chancellor for Health Affairs, Snyderman started talking about personalized and “prospective” health care more than a decade ago.   At the time, he predicted that medicine would move away from traditional reactive methods for treating disease. Instead, doctors would start using personalized data and health care planning to provide a more preventive, targeted, and individualized approach to health care.

It’s taken some time, but Snyderman can point to several areas where this approach has taken root.

“A major basis of optimism in the war against cancer relates to the development of personalized approaches to each patient’s specific disease,” said Snyderman in a recent interview with The Blog.

Breast Cancer Example

In the case of breast cancer, for instance, genetic tests and other kinds of tests can help determine who will benefit from certain types of drugs and who might suffer serious side effects. Analysis of the cancer itself can also decide on its molecular characteristics and what drugs should be used to attack it most effectively. Essentially, this approach is about getting the right drug to the right patient.

“Companion diagnostics used to identify the appropriate patients for targeted treatments are already being practiced to great success,” Snyderman said.

Between 20-and-30 percent of breast cancers are more aggressive because they overexpress a protein called human Eepidermal growth factor receptor 2 or HER2/neu. Tumors with an overexpression of HER2 tend to reoccur more often and have much worse outcomes. But by using biomarkers, genetic and other tests to identify these patients, drugs like Herceptin ® or Tykerb ®   can suppress the expression of HER2 and improve outcomes.   (Dr. Snyderman previously worked for Genentech as a senior vice president for Medical Research and Development and helped put Herceptin ® into preclinical development.)

Other Examples

Snyderman points to other examples, including the targeted use of the drug Gleevec ®, a kinase inhibitor used to treat chronic myelogenous leukemia, a cancer in white blood cells. In certain acute cases, the mortality rate had been 80 percent, but with the targeted use of the drug treatment, as many as 90 percent of patients go into remission, Snyderman said.

Beyond these targeted drug therapies, molecular diagnostics can now be used as predictive tools.

Allomap ®, which is based on gene expression testing, can help in predicting outcomes for heart transplants and avoid needless heart biopsies,” Snyderman said.

Disease Drive Event

While these were just a few of the many good examples of what he sees as models for personalized medicine in practice now, Snyderman said there are still many obstacles to transforming the system. One is the culture of traditional medicine, where care is disease-driven event.

Then there are the problems with how we pay for health care. The current fee-for-service model rewards expensive interventions instead of healthy outcomes.   Finally, patients not only need to be invited into the conversation, they also have to be willing to engage.

“The first thing we need is to have consumers involved and engaged in their own health,” Snyderman said.

In part, that’s what he likes about 23andMe.

“Just the fact that consumers might approach some type of technology that gets them thinking about their health is a good thing.”

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