You may have heard the term “precision health” bandied about in the last few years. Perhaps it conjures an image of a scientist in a high-tech laboratory. Or perhaps a new, high-tech medication. But what does “precision health” actually mean?
What is Precision Health?
Essentially, precision health is the idea that we can customize health care at the individual level. For example, finding the right diagnosis for the right person, finding the right treatment the first time around (reducing trial and error), and delivering care at the right time.
The North Carolina Precision Health Collaborative explains it like this:
Precision health combines data about an individual’s genes, environment, and lifestyle with innovation and diverse partnerships to more precisely predict and diagnose disease, target therapies and personalize health and wellness plans.”
How is Precision Health Used Today?
Currently, two of the most advanced applications of precision health are targeted cancer therapies and pharmacogenomics.
Precision health for cancer treatments relies on genetic information. Using technologies like next-generation sequencing, clinicians can sequence a patients’ genome to understand their risk of developing certain types of cancer. Or, if a patient already has cancer, researchers can look at the DNA of the cancerous tumor to predict which treatments might be most effective.
Scientists can perform similar research for other types of treatment. Pharmacogenomics sounds complicated, but the basic idea is that a person’s genes can influence how they respond to medications. Pharmacogenomic research, then, can help scientists develop new, effective medications. It can also help doctors decide which medications to prescribe their patients, based on that patient’s genome.
But Precision Health Currently Falls Short of Its Potential
Targeted cancer therapies and pharmacogenomics are incredible advancements. However, many experts believe that the promise of precision health has yet to be fulfilled.
Dr. Tim Wiltshire, associate professor and Director of the UNC Center for Pharmacogenomics and Individualized Therapy, explains this trend. “Oncology is really leading the field when it comes to precision health, because there you have an immediate situation, you need to know something about the tumor. So genetics and drug medication choices and things have really come to the forefront there. But I think other areas are really lagging behind.”
Precision Health Faces Barriers to Adoption
Another element of slow progress in precision health is low clinical uptake. “We know so much,” says Dr. Wiltshire, “about how to individualize health and individualize medications, and from genetic perspective we know how to diagnose disease and treat disease, but it still hasn’t filtered into the clinic well enough.”
There are several reasons why, he explains. “It’s a lack of education for patients and for individuals, it’s a lack of education for physicians too, because there’s still not enough true precision health information coming into the training for physicians. It’s getting there, but it’s sort of coming in too slowly, I think,” he says. “Those are key things, but we also have to get the issue of what’s the value and the payment for this, coming into play as well. That’s certainly an issue we have to deal with.”
Genetic information doesn’t provide all the answers.
Dr. Michael Olivier is a professor in the department of internal medicine at Wake Forest University. He’s also the Director for Wake Forests’ Center for Precision Medicine. He argues, “Ten or twenty years ago, as part of the Human Genome Project, we probably over-promised and under-delivered … We’ve made tremendous progress in a lot of areas. But for the more common diseases that affect the majority of our patients, genetic information doesn’t really provide a lot of actionable information for a physician. What am I going to prescribe you differently, right?”
Rebecca Boyles, a bioinformatics scientist at RTI International, agrees that we need to move beyond looking at genetic information in hope finding easy answers. “Many people have realized,” she says, “that, actually, biology is just much more complicated than we thought. What we need is systems biology approach.”
A Systems-Biology Approach for Precision Health
The Institute for Systems Biology defines systems biology as “a holistic approach to deciphering the complexity of biological systems that starts from the understanding that the networks that form the whole of living organisms are more than the sum of their parts.” Free of jargon, let’s call systems biology a way of accounting for complicated networks in all scientific research.
In the context of precision health, accounting for complication means we can’t just view people as the sum of their genetics, medical history and lifestyle. We need to understand how all those pieces fit together and influence one another.
But understanding a complex system is, well, complex. You need a lot of data from a lot of different sources – genetic information, eating habits, socioeconomic factors, and more. And then, you have to put all that data together to learn something useful.
Boyles explains, “One of the challenges the field still has to face is bringing the data from these different domains together, so that those queries can actually be asked. Because these are historically very different domains. That kind of cyber-infrastructure is not really existent today.”
Data integration is critical to understand common chronic conditions.
Despite the challenge, experts like Boyles believe that data integration is crucial to move precision health into broader public health applications.
We’ve focused so much on some of the early successes in precision health, which were around drug sensitivity and cancer. But from a public health perspective, from some of the chronic disease perspectives around diabetes and some of these big public health concerns, we need to ask these cross-cutting questions which bring together some of these more common risks that ask, What can you do if your person living in Durham, North Carolina who also smokes, who also has a high-stress job, to control the risk for a particular situation? And that’s a big data problem, from my point of view.”Rebecca Boyles, MSPH, Bioinformatics Scientist at RTI International
The full promise of precision health hasn’t yet been realized, but there’s reason to be hopeful. The NC Precision Health Collaborative (NCPHC) has gathered a wide variety of stakeholders around this movement, including universities, health care systems, pharma companies, and health insurers. With any luck, their work will facilitate fruitful collaborations to benefit our state’s healthcare.
For more information on North Carolina’s health innovations, check out our guide to the NC businesses in the COVID-19 vaccine race. Or else, look through our coverage of North Carolina telemedicine changes.