Are we ready for Personalised medical treatment?

Physicians have always treated disease after their onset. But the sheer increasing number of disease and the escalating costs of treatment has made many think about ways to prevent disease before they occur. Disease prevention is thought of as Primary Prevention when preventive steps are taken before the first episode of the illness itself. It would require the treatment of risk factors that if left uncorrected would lead on to disease. For e.g., treatment of Hypertension, Diabetes and Dyslipidaemia before the onset of Cardiovascular diseases such as Heart Attacks and Strokes. Secondary Prevention are steps and treatments that are given to prevent the second episode of a disease. This would be the medical treatment of Cardiovascular disease with anti platelet drugs such as Aspirin, Statins etc. Primordial prevention refers to correction of lifestyle abnormalities at a very young age much before the onset of even the risk factors for the disease. These would include regular exercise, maintenance of ideal body weight, adequate sleep, intake of a well balanced diet and dietary supplementation.

 

Although most doctors have focussed their efforts on treating already established disease, it is becoming increasingly clearer that adopting preventing strategies may be the need of the hour. While recommendation exist from world bodies such as the WHO, the questions many physicians are asking is if medical therapy can be individualised and personalised. Is there a way to identify the risk for disease even before disease onset? Would genetic test be of any help in identifying risks of Non Communicable diseases (NCD – heart and vascular disease, Kidney failure, Cancer etc)? Can they be used to guide personalised recommendations for disease prevention?

 

Genetic tests have been used to predict risks for Breast and Colonic cancer and those with high risk are also advised an option of surgery to reduce that risk. Pharmacogenomics and Neutrigenomics are terms that are used to describe the prescription of pharmaceutical agents and nutritional supplements to reduce the risks of cancer/disease. This field, although in its infancy provides hope of big achievements in personalised Primordial preventive strategies.

 

A recent article in an International Medical journal  discussed the effectiveness of genetic testing to suggest disease susceptibility and to suggest preventive measures in an attempt at primary prevention of diseases.Their findings suggested that genetic testing had a 25% sensitivity only of predicting future events and that current evidence isn’t enough to suggest widespread screening using these tests. The low sensitivity (accuracy) of these tests could be explained by the observations that the genes that confer risk are multiple, the interaction with each other and with lifestyle factors complex and our understanding of them rudimentary at present!

 

Although very attractive, the concept of Personalised Preventive Medicine is a long way off and for now would only interest researchers or those who are simply curious to know what their genes may be saying. Even if the sensitivity of genetic testing is low, it might give the curious an insight into their disease susceptibility risks and suggest ways to modify their lifestyles to prevent disease in the future.

 

Genetic testing isn’t very expensive and can be done at Chennai for Rs. 20000/- The tests include identification of genes predicting Non communicable diseases, genes for drug allergies and for prediction of drug interactions.

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