Will Personalized Medicine Change Doctor Visits?

If you’ve recently been diagnosed with a disease like diabetes, your doctor may talk to you about precision medicine. This type of cutting-edge treatment (also known as personalized medicine or genomic medicine) uses your genetic information, along with cues from your lifestyle and your environment, to prevent and treat disease.

Right now, the field is in its early stages. But it’s getting more common every year. Doctors already see success with precision treatments for diseases with a genetic link, like cancer and cystic fibrosis. Experts don’t know exactly how it’ll change your primary care doctor visits, but they do think you might start to notice a difference sometime in the next decade.

Is Precision Medicine Right for You?

Check with your doctor to see if precision medicine is right for you. If there's something about you that raises your odds of getting a disease, like a family history of a genetic disorder, and you want to try it to prevent it, ask about genetic testing.

If you’ve already been diagnosed with a serious condition like cancer or HIV, your doctor may be the one to bring up precision medicine. But if she doesn’t, you can ask, “Would getting a genetic test help guide my choice of treatment?”

“Most often, we use it for advanced-stage disease, such as stage IV cancer,” says Milan Radovich, PhD, medical co-director of the Indiana University/IU Health Precision Genomics Program in Indianapolis. It's already being used against HIV and in pharmacogenomics (that is, prescribing medication based on your genes).

Tests and Questions

Most of the time, you’ll start the process with a genetic test. “Because of your genes, your doctor has an extra set of information that may help determine your treatment plan,” says Stefan C. Grant, MD, an oncologist at Wake Forest Baptist Medical Center in Winston-Salem, NC.

The doctor may collect some of your blood or spit. If you have cancer, she may need to perform a procedure called a biopsy to remove a small piece of your tumor. She’ll send the samples to a lab for analysis.

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In addition to talking about your health history, your condition, and your treatment options, she will have a few more questions to ask than usual. You’ll talk about things like where you grew up and where you live now. You might revisit lifestyle questions you haven’t answered in a while:

  • Do you smoke?
  • Do you drink?
  • How well do you sleep?
  • How much -- and how often -- do you exercise?
  • Were the water and air where you grew up clean or polluted? What about the water and air where you live now?

That’s because precision medicine isn’t just about how your genes affect your health. It’s about how genes, environment, and lifestyle work together to make you more or less likely to get a disease or to find out if you’ll react better to one treatment than another.

What Will Treatment Be Like?

It can vary, depending on what condition you have and where you're treated. For example, the IU Health Precision Genomics Program, which Radovich runs along with Bryan Schneider, MD, is one of the first to have a fully integrated team for people with cancer.

If you go there, you’ll probably be referred by your cancer doctor, Radovich says. You’ll attend an educational session that explains genomics. A doctor will take a biopsy for genetic tests, which you may hear her refer to as genetic sequencing.

Then a board of roughly 20 health professionals, ranging from pharmacists and nurses to pathologists and oncologists, will get together, review your results, and come up with a plan. Your doctor will explain the results to you at a follow-up visit, then you’ll go back to your regular oncologist for treatment, Radovich says.

The IU Health program also tracks your progress through your oncologist and medical records. That provides them with information they can use to help others in the future.

At other places, however, doctors may work with smaller teams, or they may team up with other medical centers. If your doctor doesn’t practice precision medicine but thinks it would help you, she may refer you to another doctor or hospital.

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Make the Most of Your Visit

No matter what your health status is and where you receive care, here are three questions that can improve your doctor visits:

1. What if there’s no targeted treatment for me? Genetic information doesn’t guarantee individualized, or “targeted,” treatment. “If genetic testing shows that you’re not a candidate for a particular medication -- for example because it only works on a tumor with specific mutations -- ask about other options,” Grant says.

Even if they don’t have a genetic finding that can influence treatment, Radovich says, “Our precision medicine tumor board will still put our heads together to decide the next-best course for you.”

Keep in mind that most standard, nonprecision medicine treatments, including traditional chemotherapy for cancer, still work really well. And if one doesn’t get the job done, your medical team will keep working with you to find other options.

2. What are the risks and benefits of this treatment plan? You’ll want to be clear on both the pros and the cons, Grant says. If you aren’t sure about any aspect of your treatment -- even if it seems minor -- speak up. You might ask a friend or family member to come with you and take notes. If you forget to ask something, call the doctor’s office ASAP. Don’t wait for your next visit to get more information.

3. What’s the goal of my treatment? Right now, precision medicine aims to control diseases rather than cure them. But you should talk to your doctor about her goals for you.

When Prevention Is Your Prescription

Treatment isn’t the only part of disease management where precision medicine will play a role. Over time, this new field also aims to:

  • Find better ways to gauge your risk of getting a disease
  • Create screening tests that can spot disease before symptoms show up
  • Help parents figure out if they can pass diseases on to their children

How might this play out in the real world?

Say you go to the doctor and she sees signs that you’re likely to get type 2 diabetes -- you’re overweight and your blood sugar is on the rise. The first thing she’ll tell you is to get more exercise and change your diet. It’s up to you whether you do it or not, but imagine how much more that message would resonate if she says your genes confirm that you’re more likely to get the disease than other people.

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The doctor might even be able to give you certain medications that help people with a genetic profile similar to yours stave off the condition. Or maybe she’ll connect you with a proven prevention program to help you make those lifestyle changes.

Or if your genes and family health history show you might be likely to get a certain type of cancer, your doctor can order a specific test and maybe catch the cancer before it starts.

Looking Ahead: The Role of Biosensors

What’s a biosensor? It sounds futuristic, but the technology is here. Millions of us wear a nonmedical biosensor every day. That fitness tracker on your wrist gives you tons of information about your exercise habits, sleep patterns, and maybe even your heart rate. You use the information it provides to adjust your behavior and improve your health.

It may not be long before your doctor suggests you wear a different type of biosensor as part of a precision medicine care plan.

He might implant a tiny gadget under your skin, stick a patch on your body, or give you a device to wear or carry. These gadgets can measure many different things about your body, including blood pressure and blood sugar levels.

Or say you’ve recently been fainting and you don’t know why. He might look to both your genes and your heartbeat for answers. He could give you a portable electrocardiogram (EKG) device to keep track of your heartbeat over time. You could use it for a few days or a few years. You might get a wireless patch, a device with electrodes, or an implantable biosensor.

Your EKG data might suggest you have something common, like an irregular heartbeat. Or it could point to a rare genetic heart disease like Brugada syndrome. Based on information from the biosensor, your doctor will create a treatment plan just for you.

WebMD Feature Reviewed by Laura J. Martin, MD on June 08, 2019

Sources

SOURCES:

Elizabeth A. McGlynn, PhD, vice president, Kaiser Permanente Research, Oakland, CA.

National Institutes of Health/All of Us Research Program: "About the Precision Medicine Initiative."

Milan Radovich, PhD, medical co-director, Indiana University/IU Health Precision.

Genomics Program, Indianapolis.

Eric Dishman, director, All of Us Research Program, National Institutes of Health.

Stefan C. Grant, MD, oncologist, Wake Forest Baptist Medical Center, Winston-Salem, NC.

The University of Utah Genetic Science Learning Center: "More Examples of Precision Medicine in Action," “What is Precision Medicine?”

Intermountain Healthcare: "Talking to Your Doctor: Precision Medicine."

Genetics Home Reference: “What is precision medicine?”

USCF: “Behavioral/Social Discovery.”

Diabetes Care: “Precision Medicine: Is It Time?”

The Nation’s Health: “Public health, prevention to play role in precision medicine: Interventions aimed at individual risks.”

Fitbit.

Critical Reviews in Biotechnology: “Personalized diagnostics and biosensors: a review of the biology and technology needed for personalized medicine.”

Massachusetts Institute of Technology.

Medtronic.

Progress in Cardiovascular Diseases: “ECG patch monitors for assessment of cardiac rhythm abnormalities.”

American Heart Association: “Cardiac Event Recorder.”

Journal of Human Genetics: “Genetics of Brugada Syndrome.”

Practical Precision Medicine: “Syncope.”

CDC: “African Americans and Tobacco Use.”

National Institutes of Health: All of Us Research Program: “Data and Research Center,” “Scale and Scope.”

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