Blog: Medical Research Council, Stephen Holgate, "The precision medicine revolution: putting the patient first"

[Andy]

Might be of interest to some.

Precision medicine is putting the patient at the centre of healthcare. But what does precision medicine actually mean? And if you’re interested in using it in your research, where do you start? We’ve created a guide to help, explained here by Professor Stephen Holgate, MRC Clinical Professor of Immunopharmacology, who led the work.

Put simply, precision medicine aims to ensure that the right patient gets the right treatment at the right time.

Our genetics, together with our lifestyles and our environment, determine our health. Precision medicine is an exciting approach that will help to determine our individual risk of developing disease, detect illness earlier and determine the most effective interventions to help improve our health, whether they are medicines, lifestyle choices, or changes in diet.

The current approach to drug development assumes that all patients with a particular condition have the same response to a given drug. This means that all patients with the same condition receive the same first-line treatment, even though it may be only 30 to 60% effective. An alternative approach is urgently needed because currently we are giving treatments to patients in whom they either do not work or have side effects.

https://www.insight.mrc.ac.uk/2017/...edicine-revolution-putting-the-patient-first/

 

[Viola]

He seems to prefer imprecision medicine for ME patients

 

[Wonko]

Surely in a deterministic universe our health was determined, along with what drugs we will take, what treatment we will receive, and what will end up dispatching us, as well as what we will eat for breakfast, around 14 billion years ago - or by god, whichever belief system you subscribe to.

It's all gonna happen, it will/have happened, relax, unless it was predetermined at the beginning of time, it's not your fault, and if it was, it can't possibly be.

So it's all "good" for a given value of "it's"

 

[Woolie]

So he's saying that you should ask the patient every now and then whether the drugs you're prescribing and helping or not. Wow - who would have thought of that?

 

[Alvin]

This is almost nonsense, we do not have the technology to get to medicine at this level. That said we will one day and its not a terrible idea, but if we dump money on it now in a few generations we would get to this level. At this point there is far greater return in spending limited money elsewhere, this is worth pursuing but its promise is not likely to come around in a grand way in our lifetime, though i would expect some small advances over time

 

[Amw66]

Not nonsense. My daughter is currently doing a masters in " stratified medicine", having done a degree in chemistry.

This course has been running for a few years and is funded by Scottish government - illness/ genetics/ business/personalised care. In Scotland there are a huge amount of chronic illnesses, and Celtic genes can play a part.

Its aim is to kick start personalised medicine; key aspects are drug development and business models - particularly keen on the entrepreneurial small companies working up new ideas - effectively outsourcing some R+D for specialist niches.

One of the more innovative Edinburgh versions of these has been bought out- they outsourced their whole process by reading research to determine potential for specialist molecules, hired chemists and labs to test and develop , then sold onto larger company for further development. This suits post uni start ups - biochemistry is quite strong here.

Yes, usual subjects will be heart disease and cancer, but MS is higher here too, and metabolic research is done at Dundee and Glasgow.

 

[Alvin]

I did say almost nonsense, Its near term potential is not very high except for a few niche areas. In a few generations it will be huge and the longest journey does start with a single step, so i support such research but would not direct huge amounts of resources away from other research to this assuming it will pan out any time soon.

 

[Woolie]

Its aim is to kick start personalised medicine; key aspects are drug development and business models - particularly keen on the entrepreneurial small companies working up new ideas - effectively outsourcing some R+D for specialist niches.

@Amw66, a lot of what you describe sounds like business hubris. Can you explain the part that is individualised? Is it the actual treatment, or is it more the trimmings?

 

[Jonathan Edwards]

I agree with Alvin's point, in that if anyone thinks this idea is 'new' they are unlikely to be much use at medical research.

Those of us who have been productive in producing new treatments would regard the general idea as so bloody obvious that we have been doing it for decades. And as Alvin says, most of the time it makes no real difference and main efforts should be elsewhere. Of course one looks for differences between individuals. But Holgate does not even understand disease causation, repeating the old mistake of 'genes and environment'. If he had looked at a book he would have discovered that it is more complicated than that. This is dumbing down for commercial reasons and is the main reason why biomedical science is getting more or less nowhere at present other than lining the pockets of commercial sharks with buzz words.

 

[Alvin]

And as Alvin says, most of the time it makes no real difference and main efforts should be elsewhere. Of course one looks for differences between individuals. But Holgate does not even understand disease causation, repeating the old mistake of 'genes and environment'. If he had looked at a book he would have discovered that it is more complicated than that. This is dumbing down for commercial reasons

Indeed
I have heard of a few instances where blood tests or genetic tests can determine if a medication will be tolerated or what doses to start with but this type of medicine is more star trek-ish then realistic so far. By the time the Enterprise is built i expect ME/CFS will have been cured

I have a relative with Parkinsons and i have been (morbidly) fascinated with how his progression deviates from the norm and have wondered why but in the end if research money was spent on figuring that out instead of finding the disease mechanism, cause and cure then we are only wasting money and time.

 

[Amw66]

Yes, there is a lot of truth in @Alvin and @JonathanEdwards' view - this will enable bigpharma to continue to outsource risk and produce " soundbite" medicine.

But as i understand it ( and i could be wrong), there is also an interest in being able to deliver the right drug at the right time based on an understanding of the individual's needs and genomics.

For ME, this will take time, as the mechanisms are still to be unravelled, but given some similarities with other illnesses, ( for some)this may act as a catalyst..it could provide treatment for aspects of the condition , and/ or build up genomic info - enable targeted research.

For MS/ RA/ heart diseases etc it would potentially offer more effective treatment/ ability to manage longterm conditions far better. This is the aspect that Scottish government are interested in.

Her thesis last year was based on developing a biochemical probe molecule to help unravel mechanisms for complex 1 in mitochondria - as ever given we are in Scotland -to understand and later develop drug research for ischemic reperfusion injury . It was/ is interesting stuff, but at the stage where i just checked grammar!

 

[Valentijn]

As @Jonathan Edwards said, this is simplistic to the point of being complete nonsense. I would also argue that emphasizing lifestyle in this manner is inappropriate. Lifestyle very rarely causes poor health - more typically it merely has a minor impact in how poor health is managed:

Our genetics, together with our lifestyles and our environment, determine our health.

I also suspect Holgate is still pushing for MEGA in this blog, much as Crawley was in her recent TEDx talk, also without mentioning it by name. In which case we're still at the stage where they need to sincerely acknowledge the damned symptoms, not try to figure out which specific form or combination of CBT/GET and an antidepressant is most effective for "fatigue".

 

[Sean]

If people are interested in the effect of 'lifestyle' on health outcomes, the first thing they might want to look at is poverty and the real reasons for it. The ones that have nothing to do with alleged psycho-moral deficits in the poor.

 

[Jonathan Edwards]

But as i understand it ( and i could be wrong), there is also an interest in being able to deliver the right drug at the right time based on an understanding of the individual's needs and genomics.

Absolutely, but there has been ever since I was a medical student fifty years ago and before that. How could one not have an interest in this? Giving it a special name is just an admission by Holgate that he hasn't encountered something called common sense.

 

[Amw66]

Sadly altogether too true for many....
We live in hope ( and numerous other cliches)