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The Precision Medicine Initiative

Over the past 50 years, there has been a growing “one size fits all” attitude to practice in medicine. Diseases are treated as happening to a patient, and each disease has a specific treatment. But this overlooks the variability in individuals, and there has been a recent push back towards putting individual patients at the centre of care. This was highlighted in 2015, when President Barack Obama announced The Precision Medicine Initiative. This initiative hopes to push individualized medicine into the mainstream, powering $215 million of research into pioneering new research and technologies.

 

Individualized medicine relies on the principle of interperson variability. Each patient is different, and as such should be treated differently. Each patient has a genetic code, which is different in every individual and defines everything from what they look like to how they metabolize drugs. It has long been noted that many patients react differently to the same drug. A number of factors can affect this although the major one is the patient’s genetics.

 

In 1954 the field of Pharmacogenetics was born when two German physicians noticed variable reactions to the anti-TB drug Isoniazid. This difference was caused by the different genetics of patients. Each gene has variations, or polymorphisms, between individuals that affect the function of the protein that is built from that genetic code. In some individuals, these polymorphisms mean they metabolize certain drugs slowly or not at all. An example of this is the gene CYP2D6, the protein to which it makes turns codeine into its active form morphine. Some individuals metabolize codeine slowly or not at all, meaning they never produce the active analgesic (anti pain medication) morphine. These patients exhibit no pain relief from codeine.

 

This simple example of codeine metabolism can be extrapolated to hundreds of drugs and genes. This is what MD Labs achieves with Rxight®. We sequence many genes and identify polymorphisms that are likely to affect the action of over 200 drugs. From this physicians and pharmacists can produce a picture of how a patient is likely to respond to certain treatments. This allows them to choose the right medication, the first time.

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