The sole focus of the healthcare industry is the patient and how to provide the best care possible to them. Traditionally, this is based on the foundation that the same disease usually has similar pathology and will respond to similar treatment for different patients. This one-size-fits-all approach has indeed been effective for the majority of patients. But we must remember the rest who do not conform to this approach.
What if we can improve the current standard of care for all?
This is where precision medicine comes in. It acknowledges that our health is shaped by genetic factors, lifestyle choices, and other behavioral traits interacting in a complex environmental ecosystem.
All these may affect the same disease differently for different patients. That is why tailored intervention, e.g., a unique intervention designed for each individual, is increasingly stressed. If implemented broadly, this can significantly change how the treatment is provided. The healthcare industry will then need to revise its strategy of emphasizing general disease and targeted therapy to the right drug for the right patient at the right time.
The science of making it to the point
The main idea of precision medicine is that the physician will assess each patient’s genetic, behavioral, and environmental factors first. The data generated will help identify which treatment is more likely to be successful for that patient. We already use precision medicine in certain conditions like cancers and genetic diseases.
For example, breast cancer biomarkers can reveal whether a patient needs aggressive treatment or a more conservative approach. But the application could be much more, like genomic profiling of the patient to identify the risk of specific diseases, assessing the response to certain medications (pharmacogenomics), and so on.
Precision medicine is also used as a preventative tool. If someone has risk factors for breast cancer, the physician may ask her to start screening at an earlier age than recommended. This pertains to a broader application of this concept, known as precision health or precision public health. An example of its application could be the salmonella outbreak. Bacteria collected from the stool sample of the cases can be matched to find a cluster. Further information analysis could identify the infected source, e.g., a certain brand of egg contaminated with the bacteria. Then a recall of the eggs could be implemented, avoiding further public health hazards.
Impacts of personalized medicine
How does the application of personalized medicine affect the healthcare industry? Or, more specifically, the pharma industry?
There are both opportunities and challenges. Research-based pharmaceuticals are already investing in personalized treatment for specific areas, like cancer and neurology. The idea is this enhances the value proposition by enhancing the clinical effectiveness in high-risk populations as opposed to the low yield of more traditional approaches in those groups. In countries with a strong health insurance system, such an approach can also make reimbursement procedures easier. A big impact will be on drug development. Currently, it is a long process with a lot of hits and misses. Precision medicine can shorten the timeline by making drug designs and trials more specific.
Challenges
Drug development is an expensive process, and using new technology will add more to the cost initially, even though costs may come down in the long term. Also, applying precision medicine will need new skills, expertise, methodologies, and techniques to be developed. All these are significant investments that only a few big pharmaceuticals can make. They will affect the initial pricing of the new molecules, which may prove to be unaffordable by the vast majority unless they have insurance or other support systems.
But the industry is not daunted by these, and already research-based companies are spending heavily to incorporate precision medicine in their strategy. According to Strategic Market Research, Precision Medicine Market accounted for US$ 65.22 billion pharma market in 2021. This is expected to climb to about US$ 176 billion by 2030. The major growth drivers are estimated to be cancer and biological therapies. Currently, in terms of revenue, the largest share comes from cancer and drug discovery. The Pharma companies have a significant market share in precision medicine, with 33% in 2020.
Prospects in Bangladesh
In countries like Bangladesh, precision medicine faces manifold challenges. We lack the population data that is essential for this. Financial constraints are also a major issue. But we have at least started. Biomarkers are being used to tailor treatment for certain cancers. Preventive strategies based on patient’s individual risk factors are also gaining prominence. Many hospitals have already switched to electronic patient records, generating the blocs for big data.
But is it transforming the industry? Or how exactly is it affecting the pharma industry? The process has just started, and the results will not be visible for some years. The healthcare industry is still focused on providing treatment based on disease, not on individual characteristics, except for certain conditions. For chronic diseases like diabetes, asthma, and chronic obstructive pulmonary disease, the opportunity for personalized treatment is not exploited. But some research-based companies operating in Bangladesh are working to facilitate the broader application of personalized medicine in cancer and neuroscience.
Way forward
It will require shifting the whole business strategy, from a group of patients to individual patients, from standard to personalized treatment. The private sector should come forward to popularize the concept, create a system to capture population-based data, and fund the analysis of the data set to identify where we can utilize precision medicine best. The industry can also collaborate with international partners for genomic profiling and pharmacogenomics. Sure, the initial investment will be huge, and the cost of the medicine will rise at first. But with proper planning, we can mitigate the price impact, and the eventual return should be worth it.
