Personalized & Precision Medicine: October 2018

Francis Collins: Precision medicine has made great strides but has yet to reach full potential

Paige Minemyer

Oct. 4, 2018 (Fierce Healthcare) – For decades, medicine existed in “one-size-fits-all land,” but with new technology that’s changing, according to Francis Collins, M.D.

Collins, director of the National Institutes of Health, said that the advent of precision medicine is the result of physicians and researchers realizing that approaching healthcare that way doesn’t always work.

“It is such a promising opportunity to transform the way we approach medical challenges,” Collins said. “Wouldn’t you rather, if you need a medical intervention, have it take account of your health behaviors, your lifestyle, your genetics so that you end up with a recommendation that has the best chance of working for you?”

Collins spoke at The Atlantic Festival this week, highlighting both the progress made in precision medicine and the challenges that remain.

Collins said that the most obvious place that precision medicine has taken off is in oncology, but genomics holds promise in emergency areas, as well. Neurological disorders, for example, maybe be the next frontier for precision medicine.

More research is needed into diseases like Alzheimer’s and Parkinson’s in general, Collins said, but genomics experts can identify potential genetic risk factors for these conditions. However, that work is often done too late, when a patient is already showing signs of deterioration.

Even in cancer, where it’s well established, precision medicine identifies useful treatments only about 20% of the time, Collins said.

Collins also said precision medicine has yet to reach its potential as a tool for preventive care. More and more patients are getting their genomes mapped by the companies—such as 23andMe—that are moving into this space. But that information is not necessarily being translated into an actionable format.

Collins said that he had his own DNA analyzed by three such companies and received the same map interpreted in three very different ways. In addition, providers themselves may never see these reports.

“For the most part, we’re not using that information as it’s not integrated into medical practice,” Collins said.

If it were used more effectively, he said, it could serve as a tool that’s more useful than current biomarkers like cholesterol and blood pressure.

Ensuring that providers know they have access to this data and educating them about how it can be used in their own practice may be one of the key benefits of NIH’s All of Us program, which seeks to gather health data on 1 million Americans over the next 15 years.

To date, about 115,000 people have begun the enrollment process since it started in May, and many of them work for healthcare organizations, Collins said, which is energizing them around precision medicine.

Another key tenet of All of Us is ensuring that people of color and people with low incomes are included. Collins said that about 46% of sign-ups so far have been in those groups.

“It will be unlike any platform for information we’ve ever tried to construct,” Collins said.

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