DNA is present in all of us. It carries our genetic information. It is the stuff of life. In 1953 molecular biologists James Watson and Francis Crick discovered DNA’s double-helix molecular structure. It was one of the greatest scientific achievements of the 20th century, and rightly earned Watson and Crick the 1962 Noble Prize for Medicine. The BBC is not exaggerating when it claims the pair’s explanation of how DNA replicates and how our genetic information is coded on it, “set the stage for the rapid advances in molecular biology that continue to this day”.
DNA is a star. Fictional forensic investigators are always on the hunt for DNA evidence. It can be used to trace your family history. Services such as AncestryDNA beseech people to take a DNA test to “discover your ancestors”. We know DNA tells us about the past – where we are from – but now it is going to be used to see into the future.
Earlier this year, Matt Hancock, Secretary of State for Health and Social Care in the UK, announced that everyone in England would be offered the opportunity to pay to have their DNA analysed by the National Health Service (NHS) in order to predict the risk of their developing various medical conditions. “Genomics has the potential to transform healthcare and I’m really proud that the UK is leading the world,” he declared.
Hancock’s announcement came just a few weeks after the NHS in England published a 10-year plan focused on “personalised medicine”. “Personalisation” has become buzzword for health start-ups, some medical professionals and politicians like Hancock – but what is personalised medicine?
In 2010, the Nuffield Council on Bioethics, a UK-based independent charity exploring issues surrounding biological and medical research, produced a report titled ‘Medical profiling and online medicine: the ethics of ‘personalised healthcare’ in a consumer age’. It stated that “personalised healthcare” could refer both to “healthcare tailored to a person’s specific characteristics” or “healthcare where more responsibility is given to individuals rather than medical professionals”.
The report linked the enthusiastic adoption of the idea of personalisation to “responsibilisation”, the belief that people should take more responsibility for their own health, and “consumerisation”, the belief that healthcare providers should take “a consumerist approach to healthcare” and focusing on the individual and his or her needs. Personalised healthcare is about prevention, on the one hand, and early detection, on the other.
The UK government is big on prevention, which it claims could save 500,000 lives. This could mean ramping up efforts to encourage people to adopt a healthier lifestyle, perhaps utilising one of the health apps in the NHS Apps Library, such as Active 10, an app designed to “help you get into the habit of walking briskly for 10 minutes every day”.
The private sector is also looking to cash in on personalisation with glut of health apps now on the market, both to assist prevention and detection. For example: Dr on Demand allows users to connect with a doctor 24/7 via their smartphone, tablet or computer; Talkspace is a mental health app offering “online therapy”; and WhatsUp, another mental health app, “provides daily tools that promote positive mental health and wellbeing”. There are also a number of private companies offering DNA testing and analysis, such as Helix and 23andMe. Last year funding for the digital health sector totalled US$14.2 billion, representing a 14-fold increase since 2010. The personalised medicine market is predicted to be worth US$149 billion by 2020.
We have already become more health conscious than previous generations. Even if we haven’t all embraced a balanced diet and regular exercise, we are aware of the benefits of a healthy lifestyle and many of us are already used to using health apps to ward off future problems. Prevention is already happening.
The future is detection – and the NHS’s embrace of DNA testing is just the tip of the iceberg. In the UK, the UK Biobank is aiming to scan the vital organs of more than 100,000 people to help diagnose and treat a range of diseases; it has scanned 34,000 so far. Last year, Dubai announced the 10X Initiative, a plan to DNA test three million of its residents to create a national DNA database. In the United States, the National Institutes of Health will start collecting DNA from volunteers in May as part of its All of Us programme. It aims to collect one million samples.
In the January 2019 issue of National Geographic, Fran Smith, in article titled ‘How personalised medicine is transforming your health care’, outlines in detail how “precision medicine” could revolutionise the healthcare sector.
“Rather than lump patients together under broad categories of diseases, precision medicine aims to tailor prevention, diagnosis and treatment to a person’s unique biochemical makeup,” she writes.
Smith’s article includes a number of examples of how genetic testing can be used to tailor treatment to individuals, but perhaps the most intriguing is that of Dr Michael Snyder, Director of Stanford University’s Center for Genomics and Personalised Medicine and a pioneer in the field of genomics. For the almost a decade Dr Snyder has been using himself as a Guinea pig, tracking his molecular and physiological markers in an attempt to detect problems before they occur. He has succeeded in detecting and treating Lyme disease and type 2 diabetes.
“Precision medicine flips the script on conventional medicine, which typically offers blanket recommendations and prescribes treatments designed to help more people than they harm but that might not work for you,” writes Smith. “The approach recognizes that we each possess distinct molecular characteristics, and they have an outsize impact on our health.”
Healthcare couldn’t be more personal.
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