Pharmacogenomics: Making Medicine More Personal

In an attempt to increase the efficacy of drugs, the pharmaceutical industry has shifted its focus to emphasize the idea of personalized medicine, or pharmacogenomics. The idea is rather simple: we have two different patients suffering from the same diagnosis. So what is the most reasonable and logical thing to do? Well, historically, it has been to prescribe the same medication for these patients of course. I mean, why would this not make sense, right? However, it turns out that although these people may have the same diagnosis, their bodies may treat these medications differently. Thus, it is no longer a surprise to doctors and scientific researchers when one of these patients gets cured from the disease while the other one’s system fails to recognize the drug or it leads to the creation of a detrimental byproduct. Because the genetic makeup may differ for any two given individuals suffering from the same illness, there is a high likelihood that their body may also differ in the pharmacokinetics. Thus, in order to improve the effectiveness of drug and to enhance the drug-ligand interactions for a given drug, personalized medicine was developed in order to meet this need.

However, although this revolutionary method of treating individuals may sound like the beneficial answer that makes the most sense, there are many confounding variables which prevent it from being rapidly implemented. Some concerns include, but are not limited to: lack of a strong foundation for past successes, the fact that this form of medicine is so novel can lead to misconceptions and skepticism, and other bioethical issues such as bias and prejudices for opportunities that depend on health. For example, would an insurance company really welcome an individual who is known to have a strong history of high blood pressure? Would a company bias against an individual for foreshadowing that the potential worker will not be a strong candidate due to his or her failing health? These cons have slowed the potentially rapid growth of personalized medicine in the past few years but with further research and the general acceptance by the public, there is a change that is coming.

One current strategy that is being implemented by medical diagnostic and pharmaceutical companies is the use of biomarkers and enhanced screening techniques. The use of biomarkers would mean that more accurate results would be given and thus, more information about a patient because a biomarker could be developed in order to specifically target a change in a shift from the body’s normal equilibrium. When it comes to cost and funding, this method is highly effective in a sense that it would allow for a reduced failure rate and increased accuracy for a drug to target its receptor or for the diagnosis. With this concept comes the amalgamation of pharmaceutical development through improved mapping techniques of the patient’s genome. It is useful to recall that if you take the genetic makeup of an individual, a pharmaceutical company would be likely to create a drug with an improved effectiveness with reduced side effects. The side effects are virtually unavoidable, since the chemical compound that is initially administered is altered in conformation once it is processed by the body to yield a secondary byproduct. However, by being able to understand what this secondary byproduct may do for an individual can mean the difference from a minor headache to a severe rash. The advent of genomics has improved greatly since the human genome was sequenced by the collaborative Human Genome Project. What used to take years and billions of dollars now only takes a few minutes, and at a fraction of the cost too! Perhaps this is the Moore’s Law of medicine, where the increase in technology grows exponentially over a collaborative scientific project. As technology improves, screening methods improve in the sense they get shorter and less expensive. By factoring the genetic makeup of the individual into the administration of a drug to a given patient, medicine in this sense hopes to reduce the number of failed drugs and thus, improve the quality of life for many individuals. But when cash is King, is this truly the only issue that giant pharmaceutical companies are thinking about at their big meetings?

It is almost certain that even those most companies are good in nature and adhere to a strict principle of integrity, there is another topic going around as these teams discuss issues and topics at their cheap coffee and doughnut-laced meetings. Money. Yes. The unfortunate truth? You can have the cure to cancer in a pill right in your hand, but if pharmaceutical companies foreshadow the drug to have problems, or not profitable, then they would shy away. Yes, this is true. Unfortunately, it is true. We live in a nation where even great scientific pioneers such as NASA only get half a penny of every dollar. As the astrophysicist Neil deGrasse Tyson puts it best: “If you take half a penny and cut that amount on a dollar, you will not even cut enough from the edge to get to the ink!” What this means is that science is not being done just for the science and the advancements that it can make towards society. With funding involved in order to conduct the research experiments, there has to be a profit associated with it. And I have accepted that, no problem. However, will this hinder the progress of personalized medicine and pharmacogenomics? Unfortunately, yes. However, I feel that this field is hot enough to catch on and become the “next best thing” for all companies to adopt as projects to explore. Perhaps I am a bit biased here, since I have devoted my life to this aspect of pharmaceuticals as a scientist. In a sense, I completely agree that this model that, let’s say, Roche Diagnostics uses will be of benefit to many other companies. To do science right, there must be an intense effort for collaboration over competition. This is not to say that competition yielded great results. Take the mapping of the structure of DNA for example. If all these companies were bold enough to take a risk for once, then there would be no need to concern about failure. I adhere to the principle that to fear failure is to fear success. But when you have biopharmaceutical companies that are sobbing because they lost some money over a failed product in the past is absolutely unacceptable for progress. Okay, I get it, you need to make money at the end of the day in order to be harmonious. However, if you are stunted to make further progress because you are fearful of the uncertainty of tomorrow, you are living on the regrets of yesterday. And that is truly a shame to even think about. And the entire business model is sound as well. The proponent of pharmacogenomics understands where the future of medicine must go in order to serve the needs of many, by focusing on the needs of the few. In order to continue this sort of progress, we must utilize to our fullest advantage the technology and scientific advancements that we have access to today. Although the history of personalized medicine may sound shaky at times, it is still resting on a core built on a strong foundation. Other companies could definitely utilize these technologies to their advantage in fields other than medicine. For example, this philosophy of thought could possibly create a paradigm shift in the thinking that many past consumer and retail psychologists currently have. I understand that the entire genetic makeup of an individual may not need to be known when selling a shampoo but perhaps knowing more about the consumer is not a bad thing as well. Pretty much, that is what personalized medicine is. It is a way to get to know your customer better by learning more about the patient. From a scientific standpoint, I stand firmly on this sort of approach as a new model. It is how we can prevent making same mistakes over and over again because of the fear of failure. But more so, it is a risk that scientists and companies alike must take in order to understand if this is actually what the world truly needs. Keeping with the tradition of scientific advancement, this idea is ready to be launched into full-throttle research. The question is: is the general public ready?

Although I speak firmly and fondly about the idea of personalized medicine, it is not without understanding the full drawbacks and its potentially detrimental effects. Although scientifically, exploring new ground is good and should be fostered, some bioethical questions need to be raised. Let us take another business model for example. The company Celera is hoping to launch a $200 test kit to the general public in a few months. The science behind this is amazing, but the consequences are apparent. Now, not having ever taken this sort of test before, I am given to believe that this is done through some sort of buccal swab or through a saliva sample through spit in a test tube coated with enzymes to prevent the denaturation of essential proteins and nucleic acids. Cool right? But this is where bioethical issues can and thus, will be enforced. Not having a firm history, I am unsure is Celera’s test is being offered for the right intentions. Let’s take the price. It is $200. Do the math, and it is clear to see how rapidly (and effectively) this service can be profitable. And when you are hitting the general public, it is also unclear to me if these tests are being properly taught to scientifically illiterate individuals. This goes to the idea of the selling of magic beans, for example. There are the people who say, “Wait, so you are telling me that if I buy 3, I will the 1 free? I will take it!” and there are those who truly question the legitimacy from a scientific standpoint. No, I am not saying that the entire public need or will understand fully the true science of the technology in this service. But when you have a novel concept that promises great and historically unheard of results, people may jump on this concept with closed minds and open wallets. My rational thinking leads to a great deal of skepticism here, but I do not want the general public to be taken of their money just because something sounds cool.

Let us take another issue that is more related to medicine and services provided with a strong correlation to one’s health. Let us take the insurance company for example. As mentioned above, if these tests are widely available (and for a cheap price too in a few years), then perhaps all insurance companies will require this test to be taken for its clients. It is cheap, fast and yields great results. Why not, right? Well, can you imagine a society where an insurance company can widely adopt this principle and genetically discriminate against a client just because of his or her health status or the health status of his or her family history? Perhaps an unwanted eugenic movement will be formed as well. I mean, what parent doesn’t want their son or daughter to grow up nice and healthy? Could the widespread use of this technology be of detriment to the integrity that human beings have fine-tuned on their moral compass? Perhaps this practice, if implemented would be inevitable. The truth is, however, if these tests become cheap and highly available, then it is without a doubt that an insurance company, abortion clinic or employer may adopt this into a mandatory screening that will be as associated in the future generation’s minds as an interview. Succeed for other companies is essentially guaranteed, and this sweet-tasting confection is what companies will look for when striving for perfection. But what is this success? Really, at the end of the day, if a company is able to make billions but the entire morality of mankind is altered, was this really “successful?” In this sense, scientists must think twice before unleashing these scientific advancements because when the atomic bomb is detonated, it is impossible to contain all that energy from critical mass.

Sure, the strategy is viable, and as I have mentioned previously, it is going to be profitable in every sense of the word. A construction company can only hire individuals that are in tip-top shape and thus, can contribute greatly to the company. A pharmaceutical company can reduce wasted money from drugs that prove to be unresponsive in the majority of patients. In many ways, personalized medicine is making advancements in providing a greater care for patients. But by the nature of cash flow and revenue, money and thus, profitability is a great issue (if not the greatest) in determining the direction of a company’s decision. But the idea is amazing. It is easy to imagine a world where a doctor visit could mean spitting into a cup, waiting a few minutes while the drug is synthesized and the drug having high efficacy for that certain patient with immediate results. And with the growth of technology, an emphasis on scientific spending for innovations and a strong planting of STEM field learning in younger generations, this is definitely possible. However, there are so many issues that can lead to many misconceptions and misdirection. In order for science to serve mankind, it is important to understand that risks must be made in order to achieve progress. In this field, the risks can mean lives or capital. However, without these risks in science, no achievement will be made as we crawl back into the caves and read about in books what the future could have been. Again, it is not to say that this field is not without its cons. Having such a novel idea proposed means that the future is uncertain and unidentifiable. In order to quell the discomfort of such uncertainty, the human mind tends to shroud itself in pessimistic decision making or convincing that everything will be okay by enforcing the concept of hope. Hope is a mere emotion that supports optimistic thought in a time of uncertainty. But by definition, uncertain means that you are not sure how to describe something or what might happen. This means that all attempts to explain it should cease. This is when we must understand that we should try new things scientifically every once in a while. Fear leads to uncertainty and uncertainty leads to unhappiness. However, with science, many things are possible. So although it is important to consider human beings as amazing individuals with friends and family that love them, it is also important to see human beings as biological organisms that can be benefited through scientific advancements. Thus, does it not make sense that medicine for us should get more personal?

About the Author: Kevin Kim

I have devoted my life to science and rational thinking. As a student in life's classroom, I am striving to learn something new every day. Graduate of UC Riverside, Class of 2012. Graduate Student at Keck Graduate Institute, part of the Claremont Colleges. Class of 2014 with a Masters in Bioscience. The track is pharmaceutical design and development with the ultimate goal of becoming a pharmacist who can also contribute scientifically through research. I hope that through my postings, people will no longer be crippled by stress and anxiety. Fight on! Fight Strong!

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