'Precision medicine' gets a nod in President Obama's State of the Union address

Those with a healthcare/pharma interest listening to the State of the Union address this week couldn’t help but notice the reference to a proposed Precision Medicine Initiative. “I want the country that eliminated polio and mapped the human genome to lead a new era of medicine — one that delivers the right treatment at the right time,” stated the President. “I’m launching a new Precision Medicine Initiative to bring us closer to curing diseases like cancer and diabetes — and to give all of us access to the personalized information we need to keep ourselves and our families healthier.”

It’s likely that the initiative will, if nothing else, guide some of the debate about healthcare research funding when the President’s budget arrives at Congress next month; generally speaking, Republicans have been supportive of expanded healthcare research even while they have lopped whole chunks of federal funding in previous budget debates. But the mention of precision medicine raises a number of questions—why now? And, what happened to “personalized” medicine, the previous research theme?

There has been a sporadic debate in healthcare research circles over the “precision” versus “personalized” themes; a National Research Council report from 2011 noted that in distinction to personalized, precision medicine “does not literally mean the creation of drugs or medical devices that are unique to a patient, but rather the ability to classify individuals into subpopulations that differ in their susceptibility to a particular disease, in the biology and/or prognosis of those diseases they may develop, or in their response to a specific treatment.” Precision medicine, following this logic, fits well in describing molecular diagnostic tests that determine suitability for one type of oncology drug over another, based on a genetic profile. But it seems to fly in direct contrast to the growing number of therapies being developed based on cellular immunology—using (typically) a patient’s own T cells to combat a tumor or other cancer cells. That’s personalization pure and simple.

There’s a general feeling, in some healthcare research circles, that “personalized” medicine has not followed through on its initial promise—and there’s no better way to rally interest around a new research theme than to give it a new name. Another theme, broadly detailed in the NAS report, is to arrive at a “new taxonomy” of disease based on the common genetic variations that occur among widely different diseases. At the end of the day, whatever the preferred terminology will be, the concept of using a patient’s genetic profile to determine appropriate therapy seems incontrovertible.