Is personalized medicine a myth?

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Your cell phone rings, and your brow furrows as you glance down at the caller ID.

Hello?

“Hello,” responds an automated voice. “There is a 97% likelihood that you will have a cardiac event within the next 12 hours. Please proceed to a hospital as soon as possible.”

According to experts like Eric Topol, director and chief academic officer at Scripps Translational Science Institute, technology like this – and a slew of other medical wonders – isn’t so far-fetched. In fact, some of it is already here.

There are now more cell phones in the world than there are toilets and toothbrushes, Topol said. And these phones, which have become our constant companions and virtual extensions of our bodies, are increasingly being used to track our physiology from moment to moment.

The intersection of technology, science, medicine and design has led to an explosion of apps for monitoring blood pressure, glucose levels and heart rate and measuring how well you sleep, whether you’re stressed or relaxed and whether you’re eating healthy. We have been able to harness the existing digital infrastructure to get personalized health data we did not have access to before.

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Combine wireless sensors with the study of genes, or genomics, imaging and a proliferation of health-focused social networks, and you have a convergence capable of bringing about the “creative destruction” of medicine.

That’s the term Topol uses in his 2012 book, “The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care,” to refer to the transformation that accompanies radical innovation.

This disruption, said Topol, will be characterized by the personalization of drugs, devices, screening tests and treatments.

Personalized medicine can deliver better information to help patients make an individual choice about the risks and rewards of a particular course of treatment: which medicines will work for him or her, which drugs may pose a danger and whether doses may need to be adjusted. Personalized medicine can also help profile someone’s potential risk for contracting a disease like cancer or diabetes.

But not everyone agrees with Topol.

“Personalized medicine is a myth. It’s hyperbolic,” argued Dr. Ezekiel Emanuel, vice provost for global initiatives and chairman of the Department of Medical Ethics and Health Policy at the University of Pennsylvania.

Emanuel spoke with Topol and Margaret Hamburg, commissioner of the Food and Drug Administration, on a panel about personalized medicine at the Aspen Ideas Festival this month.

According to Emanuel, tailoring medical treatments to individual characteristics of each patient is both overly optimistic and cost-prohibitive. He likened it to buying a custom-made suit versus one off the rack.

But in an interview after Aspen Ideas, Topol disputed that, saying that nowhere is the promise of personalized medicine as hopeful or exciting as in cancer research.

“We are at a pivot point when it comes to cancer,” Topol observed. “We may not have had the tools before, but we do now.”

Mapping the human genome, which initially took more than a decade and roughly $3 billion, can now be performed in a little more than an hour to the tune of $900. Several cancer centers like MD Anderson in Texas and Sloan Kettering in New York have begun identifying the genetic fingerprints of tumors and targeting specific treatments.

The first step is to sequence the patient’s DNA in order to uncover the cancer-causing mutation. Then, instead of administering a one-size-fits-all drug, doctors would use one that addresses the specific mutation.

“It’s a more intelligent, precise way,” Topol said.

The patient’s response to treatment would also be monitored. “Instead of putting them through radiation, PET scans and CT scans, which are very expensive and potentially harmful, we are now looking at noninvasive tests that do the same job,” Topol said.

One example, he said, is a promising test that uses microchip technology to sift through blood in search of circulating tumor cells, which come from solid tumors and roam through the blood.

“Both the initial treatment that addresses the root cause and the follow-up can be revamped,” Topol said. “And it’s not that expensive. In fact, it’s far cheaper.”

In addition to what he felt would be explosive costs, Emanuel also argued against personalized medicine by observing that behavioral and lifestyle changes like diet, smoking and exercise, which account for 40% to 60% of all disease, are far likelier to have an impact on longevity and health-care affordability than genetics and thus should be the center of focus.

Topol said that none of what we talk about in personalized medicine is meant to supplant efforts to improve people’s diets, lifestyles and physical activity.

But, to use one lifestyle example, there are different explanations for obesity beyond “you are eating too much.”

That approach doesn’t take into account an individual’s biological disposition. Some people are obese not because they eat too much but because they have a genetic structural variation. Others may have an issue related to their individual microbiomes: the totality of microbes, their genomes and the collective environmental reaction in the gut.

Researchers have linked certain microbiomes to obesity, which then opens the door to individualized probiotic and other therapies. “That’s the whole idea behind individualized treatment and prevention,” Topol said.

The bottom line is that when it comes to technology’s disruption of medicine, Topol believes the genie is already out of the bottle. Some of the best cancer centers are on this path. They are, however, treating a minority of the patients out there.

There are a host of barriers to realizing the promise of personalized medicine – insurance reimbursement, privacy and regulatory issues, information and aggregation issues, among others – but perhaps none so pernicious as resistance.

“The problem is that it takes physicians so long to accept a radical change. And the lag is unacceptable,” Topol said.

Resist as some might, the power of one’s own data is the future of medicine.

“It is only a matter of when,” Topol said.

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