Summary
The reactive, rather than proactive, medical paradigm of the 20th century is still used for many diseases. This approach ignores the natural history, genetic background, and pre-clinical manifestations of disease. In the 21st century, medicine has already become increasingly preventive in an aim to reduce the number of deaths due to genetic predisposition and personal behavior. Genetic information is being used to customize detection, treatment, and prevention at the individual level. The former reactive approach lacks precision, while the new proactive one reduces uncertainty and error in both diagnosis and treatment.
Early work in medical genetics was mostly focused on monogenic disorders, but with the completion of the Human Genome Project, it is now possible to understand diseases caused by environment-gene interaction with more than one genetic variant. A powerful new set of tools, genomics, proteomics, metabolomics, and lipidomics, are at the forefront of biomarker discovery for disease diagnosis. Natural variations across several genes, coupled with environmental factors, is now known to be generally responsible for influencing an individual's risk for developing certain diseases, and explains why some patients respond to a particular drug while others do not. Personalized medicine offers the possibility of specific lifestyle changes, chemoprevention, or nutrigenomic products to delay or prevent onset of a disease.
While personalized medicine is often discussed in the future tense, it is already having an impact and is an unavoidable trend in medicine, enabled by technology and knowledge of 'omics, and spurred by economics and consumerism. It is currently delivering better diagnoses, earlier interventions, more efficient drug development and better therapies, and promising more for the future. In this MedSci Update, we discuss the current status of personalized drug prescription and dosing based on individual genetic profiles, the use of biomarkers in prediction, treatment and monitoring, the integration of 'omics and biomarker technologies with imaging and clinical reference laboratories, and the upcoming challenges for personalized medicine in the technological and social realms.
Learning Objectives
- Compare and contrast 20th century medicine with
the new paradigm of personalized medicine.
- Discuss the concept of ‘omics, and relate how it is
transforming the use of biomarkers in therapeutics
and imaging.
- Describe new genotyping tools that are being used
to prescribe and dose drugs.
- Explain how individual biomarkers are used to predict, prevent, diagnose, and track disease
status.
Target Audience
This activity was developed for Primary Care Physicians,
Allergists/ Immunologists, Registered Nurses, Family and General
Practitioners, Pediatricians, Pulmonologists, Physician Assistants,
and Nurse Practitioners.
Accreditation and Designation Statement
National Jewish Medical and Research Center is accredited by the
Accreditation Council for Continuing Medical Education to provide
continuing medical education for physicians.
National Jewish Medical and Research Center designates this educational
activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM. Physicians
should only claim credit commensurate with the extent of their participation
in the activity.
Participating Faculty
Michael Salem, MD, FACS
President & CEO
National Jewish Medical and Research Center
Faculty Disclosure
All faculty in a position to control of the content of this activity are expected
to disclose any or no significant financial interest or other relationship with
any proprietary entity producing health care goods or services, with the
exemption of non-profit or governmental organizations and non-health care
related companies. Our goal is to ensure that there is no compromise of the
ethical relationship that exists between those in a position to control the
content of the activity and those attending the activity and their respective
professional duties.
Significant financial interest is defined as receiving, or in the past twelve
months having received, a salary, royalty, intellectual property rights,
consulting fee, honoraria, ownership interest (e.g., stocks, stock options or
other ownership interest, excluding diversified mutual funds), or other
financial benefit. Financial benefits are usually associated with roles such as
employment, management position, independent contractor (including
contracted research), consulting, speaking and teaching, membership on
advisory committees or review panels, board membership, and other activities
from which remuneration is received, or expected.
Disclosures of Commercial Support
KEY
# Research Grants
^ Consultant
~ Speaker’s Bureau
> Other (eg., clinical study)
David Beuther, MD
# Merck & Co., Inc.
Ronina Covar, MD
^ AstraZeneca, Merck & Co., Inc.
# AstraZeneca, Ross Products/Abbott Laboratories
Stephen K. Frankel, MD
Has no significant financial interest to report
Monica B. Hughes, M.S.
Has no significant financial interest to report
Harold Nelson, MD
^ Curalogic, Dey Laboratories, Dynavax Technologies,
Genentech, GlaxoSmithKline, Johnson & Johnson,
Novartis, Schering Plough (Integrated Therapeutics
Group)
~ AstraZeneca, GlaxoSmithKline
# Boehringer, Clinical Therapeutics, Genentech,
MediciNova, Inc., Novartis, Sepracor, Inc., Schering
Plough (Integrated Therapeutics Group), Teva
Pharmaceutical Industries Ltd., Wyeth
Michael Salem, MD, FACS
Has no significant financial interest to report
Richard W. Weber, MD
^ AstraZeneca, Genentech, Novartis
~ AstraZeneca, Genentech, Novartis, GlaxoSmithKline
# Eli Lilly and Company, GlaxoSmithKline, MannKind
Corporation, Pfizer, Inc.
This CME activity is funded by The Office of Professional
Education at National Jewish Medical and Research Center.
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