Personalised prescription

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By TOH SAW YI

The saying that one size doesn't fit all rings true in the medical field, especially when it comes to drug prescription.

Imagine a world where the medicines are tailored to your genome - no more allergy problems or side effects caused by medicines. Not to mention, you can prevent the onset of diseases, such as hereditary cancer, heart diseases and diabetes, that's genetically encoded in your body.

Indeed, this may sound like science fiction, but according to Professor Dr. Edmund Lee Jon Deon, a renowned and leading pharmacogenomics scientist, this seemingly impossible concept may just be more than a figment of imagination.

Stranger than fiction: Drugs that is especially catered to your health diagnosis may just be a viable thing.

The professor from the Department of Pharmacology at the National University of Singapore (NUS) recently gave a scientific talk entitled Pharmacogenomics and Personalised Medicine: Reality or Myth at UTAR.

Lee's impressive resume includes a variety of positions that ranges from being the vice chairman of Singapore’s Pharmacovigilance Advisory Committee (PVAC) to being the executive editor of the British Journal of Clinical Pharmacology. He is also the Consultant Editor of Current Pharmacogenomics and Personalised Medicine (CPPM).


More than just a commercial buzz

Defined as the study of many different genes that determine drug behaviour, pharmacogenomics is considered a new of branch of science.

Through new information obtained from the Human Genome Project under this study, scientists have found out that genetics' approach is no longer applicable. Hence, the concept of "personalised medicine" emerges.

What that initially started as a commercial hype soon began to garner fast track mainstream prominence.

So, what this concept all about? In layman's terms, personalised medicine is all about making a medical treatment as individualised as the disease.

Or as Lee puts it, “Personalised medicine is all about treating you as a unique individual and not as an average person based on textbook treatments.”

By identifying genetic, genomic (including family history), and clinical information (including medical history) of a patient, physicians of the future will be able to make accurate predictions about a patient’s susceptibility of developing disease.

This diagnosis will include the course of disease, and the patient’s response to treatment as well as finding the means to tailor the medicine prescription to suit the individual's own physical health needs

Consider this – Cardiovascular diseases are one of the most devastating chronic diseases in Malaysia. On average, it caused the deaths of 30% of Malaysian citizens (of all ages), which is around 26,000 people.

Most heart disease patients do take drugs to combat their disease. In spite of that, they do not actually have their blood pressure under control.

What could possible contribute to this problem?


It's all trial and error!

Well, besides the fact that most patients do not change their lifestyles to cater to the drug, there is no real way of knowing how a patient will respond to a prescription.

In other words, this is all just a matter of trial and error!

In more technical terms, in order to understand how a drug behaves in a body, it depends on the chemical resonance of the body itself.

“Just take the King of Fruits, durians, as an example. Some people may say it tastes like garbage and sewage or other gross stuff, but some people may describe it as heavenly. It all boils down to everyone’s response to taste and it’s all genetically determined.” Lee articulated the point with this simple analogy.

Riveted audience: Lee presented his talk to a packed crowd at D209.

While doctors may assure their patients by saying that most patients respond well to the drug and that it has little to no side effects, that's a rather far-fetched notion for the majority of people out there.

The reality is that the particular patient may not be just like most people and might respond negatively or do not respond at all to the drug in question – in the case for medicines, it is true that one size may not fit all.

“Sir William Osler, one of the greatest icons of modern medicine, once said that no two individuals react alike and behave alike under abnormal conditions that we know as disease, ” Lee offered.


A matter of variation

The amazingness of human variability was proven in 2009 when worldwide professional services firm PricewaterhouseCoopers (PwC) published a report detailing how patient response rates to medicines "can be very low", often hitting as low as 20 percent.

Next Generation Pharmaceutical has also reported that common asthma drugs, like Salbutamol, VentolinTM and Salmeterol, fail to work on patients with certain genetic make-up.

The report suggested that they may even make the condition worse. Not to mention, there will be a variety of other factors that will affect the treatment process. In short, as of now, it is just not possible to perfectly fit a medicine to a patient.

Think about this – What leads to the development of cardiovascular diseases?

Age is one factor (your blood vessels accumulates cholesterol as you age until the vessels get clotted that is), family history is another (if your relatives have high blood pressure, than your risk of getting high blood pressure will increase) – there are just too many to consider.

This is where personalised medicine jumps in. It is able to combine all of the information available to make more accurate predictions about who is really at risk for developing the disease and then target the person for treatment.

According to Lee, as of current, the percentage of successful predictions of a patient’s responsiveness to certain drugs is at about 60%. Furthermore, the current medicine is more focused on the reaction (treating a disease once a patient caught it and displayed symptoms) rather than the prevention.

Personalised medicine aims to change just that. It will be possible to predict susceptibility to diseases and to prevent or delay the onset of those diseases with precisely chosen medicines, therapies and customised lifestyle advice.

More effective and less toxic drugs can also be designed and prescribed to patients. What this means is that cases whereby patients sue their doctors due to allergy or other negative side effects to certain medicines will soon be a myth.

Besides that, with no more trial and errors, inflated health care costs can be reduced and doctors will be able to create a lifelong health maintenance strategy that suits a person’s unique genetic constitution.

Lee ended the talk urging present and future doctors or medical staff to take a more active part in the development of personalized medicine.

Indeed, with this kind of healthcare service within grasp, it’ll be no surprise to see even lower mortality rates due to diseases that can be prevented in the future.

“Doctors should just stop talking about it and actually do it. It’s about time to make personalised medicine more accessible to doctors and patients alike,” he concluded.

Biotechnology student Toh Saw Yi is a special correspondent for J-on.

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