Will the era of personalised medicine expose a gap in medical education?
In our personalised medicine focus month, Ashish Rishi discusses how this new era of medicine may expose a gap in medical education and proposes his thoughts on how this issue can be overcome.
People respond differently to medicines. Fact. Some respond well and their health outcomes are improved. However, some do not gain any benefits from the treatment, and some are actually harmed. One of the most important things that affect how well we respond to drugs is our genetic make-up.
If several similar drugs exist that can help treat a condition, a doctor might be able to give a genetic test to identify which drug would best suit the patient. This is the hope, but what is the reality? Although personalised medicine is likely to be important in the treatment pathway of the future, there are many scientific and medical obstacles to overcome before it is in routine use.
Personalised medicine is becoming more prominent and will have a major impact on the way medicines are prescribed to patients and, as a consequence, how they are developed in industry. A new report from BCC Research predicts that the global market for DNA sequencing products will grow to $6.6 billion by 20161. This increase from nearly $3 billion in 2011 reflects a compounded annual growth rate of 17.5%.
The market can be broken into three segments: the sequencing instruments and consumables, the sequencing services segments and work flow products. The former makes up the largest share of the overall market with revenue of nearly $1.6 billion in 2011. Experts at BCC Research, a marketing research firm, believe that this market should increase to $2.2 billion by 2016, a compounded annual growth rate of 7.3%.
“…the global market for DNA sequencing products will grow to $6.6 billion by 2016.”
On the other hand, the DNA sequencing services market that grew to nearly $1billion in 2011, from $838 million in 2010, is the fastest growing segment. At a compounded annual growth rate of 29%, this segment is expected to be $3.5 billion by 2016.
So with the possibility of personalised medicine, we face a new problem. As a recent discussion with a client highlighted, when I asked how her team of doctors were going to cope when a patient comes in with their genetic tests? The response, was startling:
“I graduated 20 years ago, pharmacogenetics, was just a concept in those days, I have learned what I learned by myself, but I would not be able to handle a series of genetic tests being handed to me or my team”
This statement got me thinking. There seems to be a need for medical education to be improved and it seems it is vital that education for both HCPs and patients needs to be done simultaneously and fast as the realization of personalised medicine is occurring on a daily basis.
So what are the challenges facing the education system? Is there a solution?
The first point to consider is that medical education needs a revamp. Genetics education that HCPs-in-training typically receive is now ill-suited for practicing personalised medicine. Medical schools should improve their curricula to include not only more basic science concepts in genetics and genomics, but also practical training for their applications in clinical medicine.
“Genetics education that HCPs-in-training typically receive is now ill-suited for practicing personalised medicine.”
To further prepare for the dawning era of personalised medicine, medical students must learn the principles of genetic variation in the human population. For example, a man who learns he has a low-risk genetic variant for heart disease (e.g., a single nucleotide polymorphism with an odds ratio of 0.90, or a decreased risk of 10%) should not in turn disrupt his exercise or diet regimen, as the protective genetic effect may be easily offset by the deleterious effect of an unhealthy lifestyle. If the variant is common in the population, its effect may be statistically significant at the population level, but not clinically significant for an individual patient.
This again ties back to the concept, which both HCPs and patients need to be educated simultaneously. In the UK, the National Genetics Education and Development Centre has developed evidence-based learning objectives and competencies in genetics for health professionals, which is a start, however much more work is needed.
Focusing on the benefits of personalised medicine will motivate the sector to improve its training, as it is an eventuality now, rather than a theory. The benefits include:
• The ability to make better-informed clinical decisions.
• A higher probability of desired health outcomes by using better-targeted therapies.
• The reduced probability of adverse reactions from medications and treatments.
• A focus on prevention and prediction of disease, rather than reaction to it.
• Earlier disease intervention.
• Reduced healthcare costs.
Personalised medicine is good, it’s here to stay. Now let’s just prepare our HCPs to deliver on the promise.
1. BCC Research (2012 ) DNA Sequencing: Emerging Technologies and Applications http://bccresearch.com/
Previous articles by Ashish Rishi include:
About the author:
Ashish Rishi, B.Sc., M.Sc. is Owner, Director of Cetas Kinetic, a healthcare training consultancy providing leadership, coaching and advisory consultancy to pharma, HCPs and medcomms agencies. Ashish combines his passion for technology and training with more 10 years of pharma expertise to help set new benchmarks for pharma. Follow @MrCetasKinetic on Twitter for irreverence, knowledge and experience.
How can pharma bridge the gap between personalised medicine and medical education?