The medicine of the future, now | By Salvador Macip

A revolution is coming that should change health systems. Until now, medicine has focused on diagnosing a disease and giving the patient the drug that has been proven to work best. But technological advances have made it possible to discover that, under the same label, often hide, in fact, various variants of the disease. And, even more important, that the genetic of each person determines how this disease evolves and how it reacts to drugs. So it doesn’t make much sense to give the same pill to everyone when we know that for some it won’t have any effect and for others it may even be harmful. what is needed is a tailor-made treatment.

This new approximation is called personalized or precision medicine, and it has already begun to be applied, for example, in some cancers, where the most effective treatment is chosen based on the mutations detected in each case. There is still a lot of work to be done before it can be applied to most diseases, which would be the ultimate goal. With this we would be able to improve the effectiveness of the treatments and, at the same time, reduce the unwanted effects.

There are three major obstacles that will have to be overcome before it becomes a reality. The first is have enough drugs for all needs. We need a library of compounds highly characterized that have already passed the necessary clinical tests, so that we can choose the one that best suits. This is a major bottleneck, because pharmaceutical companies have little interest in allocating resources to the development of a drug that it will only work for a small group of patients. Your investments are important and they are compensated with equally important sales. Therefore, it is usually the search for the product that can be sold to the widest possible population, which is just the opposite of personalized medicine.

We’ll have to find a way encourage investment in less profitable drugs, and this will require a substantial public contribution and a negotiation with the pharmaceutical companies, which are an essential part of the system. A complementary strategy is ‘repurposing’, or finding new uses for a drug that has already been approved. A compound has often been considered not useful for treating a disease because the majority of patients did not respond, but a part, no matter how small, might benefit. You just have to know how to identify them.

This is where the second hurdle appears: how to determine which people will respond best to each treatment. This is called stratify. Here the funnel is to define new stratification markers. It will be necessary to use genomics, proteomics and other omics to find these differences between patients. Finally, the third point to resolve is How to train health personnel so that they can deal with changes in protocols that require some new basic knowledge

Flying over these limitations is an obvious question: who pays for this? Everything we have pointed out requires a lot of money. And, above all, implementing personalized medicine will represent an added cost that chronically underfinanced public health systems will hardly be able to afford if there are no changes in budgets. Here it will be necessary to have the support of enough visionary managers to bet on an expensive but, in the long run, necessary transformation.

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A few days ago I was able to talk about these issues at the round table that closed the annual Barcelona conference Institute of Science and Technology (BIST), this year dedicated to precision medicine. The BIST is a multicentre research institute, with a unique structure in our country, which is doing pioneering work in this field, and the day was a good showcase of recent results that can advance the discipline. But apart from basic research, we also need to attract the collaboration of pharmaceutical companies, the support of politicians and the interest of doctors. In this sense, BIST and the UOC are preparing a personalized medicine course for health professionals that would have to help explain the changes that are coming to whoever will have to implement them.

To initiatives like this we will have to add a necessary publicity campaign so that everyone understands the importance of the issue and how it will affect us. Because the revolution that personalized medicine promises us can radically change 21st century healthcare, but first they must balance all the elements, which will require the coordinated work of professionals from various fields.

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