Latest / CareTalk: Healthcare. Unfiltered. / Can Personalized Medicine Live Up To It's Potential?

Transcript

Can Personalized Medicine Live Up To It's Potential? · CareTalk: Healthcare. Unfiltered.

• 0:00
  Everyone wants care, specifically Caleb DeBam, and that's the promise of personalized medicine.
• 0:05
  There's technologies like genomic sequencing, biogymatics, gene editing, and AI that are making personalized medicine possible, but we're really still in the early phase.
• 0:15
  So what is the potential of personalized medicine, and how soon will we see the results?
• 0:27
  Welcome to Care Talk, America's home for incisive debate about healthcare business and policy.
• 0:32
  I'm David Williams, president of Health Business Group.
• 0:35
  And I'm John Driscoll of Presby Walgreens Health.
• 0:38
  Join the ever -growing Care Talk community on LinkedIn, where you can dig deep into healthcare business and policy topics, access Care Talk content, and interact with the host.
• 0:47
  Now we don't really have a personalized version of it yet, but John, maybe that'll be sure next time.
• 0:51
  David, let's start with, what is all the buzz about?
• 0:56
  personalized medicine, what is it?
• 0:58
  And is it in any way relevant to patients and families today?
• 1:05
  It is relevant.
• 1:06
  Let me say what it is.
• 1:06
  So it's really about tailoring medical treatments to the individual characteristics, conditions and preferences.
• 1:13
  And the contrast is we're going from the one size fits all medicine to personalized approaches.
• 1:18
  And then one size fits all is because the study and it will say, okay, blood pressure should be this, or this is how you treat this and all this.
• 1:26
  And it's based on real data and real studies by the tendency to sort of give you the average result.
• 1:32
  And that's what you're hearing.
• 1:33
  So personalized medicine is getting down to the specifics for you as an individual, your treatment decisions.
• 1:41
  And there's a lot of technologies that are underlying it.
• 1:45
  Yeah.
• 1:45
  I think the context here though is important from the Watson and Crick identification of the interlinking of DNA and RNA and identifying.
• 1:56
  what was hopefully almost a map or a topography of biology, there's been this promise from the fifties and sixties that, gosh, if we could really understand in almost a mechanistic way how different genes express, which are deeply unique, and we currently care for both through drugs and general therapy, broad categories of people, we could unlock some secrets of health.
• 2:25
  We mapped the genome and so there's a genomic Atlas, if you will.
• 2:30
  So we got that mapping correctly.
• 2:31
  Yeah.
• 2:32
  Which is a big deal, John.
• 2:33
  And that took 13 years and it finished 20 years ago.
• 2:36
  And I think people thought, okay, now we have everything, but it shows just the amount of complexity actually interpret that map once we have found the map.
• 2:44
  And, but then we found that it isn't just the genes themselves and how they interact, but there's epigenetics and then the epigenetics.
• 2:53
  which is how they're expressing.
• 2:56
  Then we realized that there's a level of complexity around proteins.
• 2:59
  And so to some degree, we're sort of starting with the, the, the end view of personalized starts with, okay, one map, then you get one more level deeper and one more level deeper and one more level deeper.
• 3:09
  And at each level, it feels like people have promised that personalized medicine is going to transform care primarily in, in, on the biopharmaceutical side where we can actually target therapies to specific diseases.
• 3:22
  We should get into that.
• 3:23
  But I think to be fair, David, like a lot of early stage technologies that have grand promise that the grand promises were made early before we actually could make great progress.
• 3:35
  And maybe we could talk a little bit about kind of how it's being applied today and or misapplied so that people can kind of put it in a personalized medicine or personal context.
• 3:45
  Exactly.
• 3:46
  Let's hear John.
• 3:47
  So.
• 3:48
  You know, I get kept a little bit in your comments, the sense that, hey, the more questions we answer them, the more questions we ask.
• 3:54
  And that is true to a certain extent, but let's say there was the map and maybe, you know, in order to sell the idea of the human genome project, uh, you needed to say it's going to do all these great things.
• 4:04
  Otherwise you're not going to raise all the money for it.
• 4:06
  So that's there.
• 4:07
  Uh, and maybe that's just a little bit into the future.
• 4:09
  There is this thing called the all of us research program, which is actually the attempt to get a million individuals across the country and various diverse.
• 4:18
  demagoguities in order to understand what all this genetic information means.
• 4:24
  And they have a report that just came out and they've identified more than 275 million seriously unreported genetic variations.
• 4:32
  And there's about four million of those that have potential health consequences.
• 4:35
  So on the one hand, we're going deeper and deeper into asking the questions.
• 4:38
  On the other hand, I know you're getting to the point about like, does this need any?
• 4:41
  Let me give a couple of examples where there is actually specific benefits that are being held now.
• 4:46
  So one is certainly, Uh, mutations, bracket one and bracket two are well known, uh, that lead, you know, with very directly, very high chances to have that she can get breast cancer or ovarian cancer.
• 4:57
  And so.
• 4:58
  Although it's not something that people want to do.
• 5:01
  Um, you know, the people that have mastectomies and, uh, they have the ovaries and low P, uh, to remove, to prevent cancers.
• 5:08
  That's actually happening.
• 5:09
  Gene editing is happening for this.
• 5:11
  I mean, just, just to be clear, that is a genetic polymorphism, a genetic difference.
• 5:17
  that you can identify through a test.
• 5:20
  And I think it's like one out of three or one out of four women will have some form of breast cancer in their lives.
• 5:25
  So it's a very common form of cancer for women.
• 5:28
  And the specific cancers related to that genetic variation can be targeted with either direct therapy or surgery and save lives.
• 5:38
  So that's a great example of where by providing the map, we've identified the target.
• 5:43
  The target is tied to illness and we've actually got a solution.
• 5:47
  surgery and, and drugs to, to deal with what would otherwise be an incredibly lethal form of cancer.
• 5:54
  That's right.
• 5:55
  And that isn't the only example.
• 5:56
  So there's, we have CRISPR you might've heard about, which is about gene editing.
• 6:00
  So like directly editing a gene, uh, and for sickle cell disease, there's actually, if we could back up a second David, because I do think that when you think about it, I remember, uh, your buddy, Bill Clinton was on the, on the, on the, on the White House lawn with Craig Mentner and talking with the private sector, Dr.
• 6:19
  Craig Mentner, we've mapped the genome in the nineties and now we're going to unlock all of these diseases.
• 6:26
  Well, the reality is that the unlocking has taken a long time, but now we're getting to the point where we can not only unlock and identify BRCA1, BRCA2 specific genetic variations that lead to treatment, but CRISPR is actually a software like technology.
• 6:44
  that allows us, once we understand what that genetic polymorphism or difference is, that we could potentially use that technology and manipulate people's biology so that they could heal themselves.
• 6:59
  These are called targeted therapies and they're remarkable and CRISPR is probably as an acceleration of those targeted therapies because we literally can theoretically manipulate people's biology directly.
• 7:14
  to save lives.
• 7:15
  So we get, you know, and yes, save lives, but potentially to do other things too, right?
• 7:19
  Which is where some of the concerns come in.
• 7:22
  So if you think about Christopher gene editing for something like, you know, sickle cell disease, where you can make an edit and essentially cure at least certain people, sickle cell, that's great.
• 7:30
  That's kind of like a cell checker.
• 7:32
  And you're going to say, oh, there's a typo.
• 7:34
  I'm going to fix that.
• 7:36
  Now the thing with gene editing, you might also just type a whole new sentence and that may lead us into different, uh, different directions.
• 7:42
  A couple of other examples.
• 7:43
  So.
• 7:44
  Uh, CAR -T, which is a type of the neuro therapy, uh, where we actually genetically engineered T cells of the patients.
• 7:50
  And that could be used essentially to train individual cells to attack certain cancers, leukemia and lymphoma in particular.
• 7:58
  And then beyond some of those, some things that are purely on the software side, it was an example of hacking the continuous glucose monitor in order to allow personalized treatment and adjustment for insulin.
• 8:10
  And that's actually.
• 8:12
  grassroots open source project was done.
• 8:14
  So there are real examples, John.
• 8:15
  Let's get to that one later, but I just really want...
• 8:20
  I mean, these are...
• 8:22
  I think it goes back to that...
• 8:24
  What I'm reminded of is the Bill Gates quote that we tend to overestimate initially the impact of technology in the next two years and underestimate the impact in 10.
• 8:34
  CRISPR and targeted immunotherapies literally...
• 8:39
  permit the manipulation of biology for, to create a potentially better outcome.
• 8:44
  There are, there are the sickle cell diseased disproportionately hits people of color.
• 8:50
  And it is genetic and it is a genetic variation that we can potentially reverse targeted immunotherapies where we actually use the equivalent of bio biological weapons to attack different forms of cancer.
• 9:06
  Skin cancer would be another one.
• 9:08
  The CAR -Ts are, you know, leveraging T cells, which are these incredibly powerful pluripotential cells in the body to overwhelm, if you will, the cancer and accelerate in almost a superpower -like way dealing within patients' bodies.
• 9:27
  So 20 or 30 years in, after we've talked about the map, we're actually finding ways for delivery vehicles for curative therapy.
• 9:36
  The risk here, the reason why the FDA has been slow to approve this stuff is if you get it right, you can kill people because you're literally manipulating their biology.
• 9:45
  So initially a lot of the research was done on people who were desperately ill and near death anyways.
• 9:52
  And there have been cases for older people to babies where these targeted biological therapies based on personalized medicine or leveraging the insights we have from your personal DNA.
• 10:04
  your personal biological makeup to create curative therapies.
• 10:08
  But David is, it sounds like, you know, the, what would have been thought of as science fiction 20 or 30 years ago, and we're going to cure everybody.
• 10:17
  Like what, what could possibly go wrong here?
• 10:19
  Yeah.
• 10:19
  Well, John, before we think about what could go wrong, cause I think that's, you know, there's a lot that could go wrong, but we're talking about, okay, the great promise into the future.
• 10:28
  And your point about things being overestimated in the near term and then underestimated in the long term.
• 10:33
  One of the reasons for that is that these technologies don't exist in a vacuum.
• 10:38
  And when multiple things come together, they can be combined in new ways.
• 10:42
  One way to think about that is maybe with something like a smartphone.
• 10:46
  Right?
• 10:46
  So it's just a phone, but it should combine the ability to make phone calls with the ability to track, uh, location and then to have video and to have computer processing all in one place.
• 10:58
  Now you can do all sorts of things completely, really invented like ride sharing never would have been just done with a, with a phone, but you actually need all of those different moments to come together.
• 11:07
  Think about that similarly as it relates to personalized medicine.
• 11:10
  So there's an example here that's just starting out called a concept of a virtual twin.
• 11:16
  So psychiatric disorders have been the hardest, some of the hardest things to actually understand it to cure.
• 11:22
  But if you combine the possibility of, you know, the genome mapping.
• 11:25
  the analysis with big data and AI, and then the possibility of doing simulation, you can actually create essentially computerized version that's a match, whether somebody's brain and you can do simulations there in a way that you could never do ethically with an individual person.
• 11:41
  And you can actually design our therapies for that.
• 11:44
  Those sorts of things, putting different technologies together, we're going to see the big impact, I believe.
• 11:49
  Yeah.
• 11:49
  Yeah.
• 11:50
  I think we should approach the personalized medicine, the broadest aspect of the categories.
• 11:54
  tied to, the most exciting ones are the ones that tie to biology and biopharmaceuticals.
• 11:59
  But when you step back and you realize that we use very generalized rules in general for dosing or prescription or for physical therapy, we realize that everybody's a little bit different.
• 12:10
  You start to step back and say, like, you know, my, my wife's involved in a personalized food program where she's leveraging diet, food, and behavior change to help people really change the arc of their health.
• 12:23
  But they start with.
• 12:24
  a really tight assessment on how and why and where do people eat right now?
• 12:29
  What is their cultural tradition?
• 12:31
  How do they think about food?
• 12:33
  Do they use it for entertainment?
• 12:35
  Is it income restricted?
• 12:37
  And by really understanding why people eat the way they eat, particularly those who are suffering from diet -sensitive chronic disease, you can't just tell people to eat more salad.
• 12:48
  That doesn't work.
• 12:49
  You need to go dial back to their personal home, family, culture, neighborhood.
• 12:54
  access traditions and kind of what they use food for.
• 12:57
  And that actually they've had some incredible results without mapping anybody's genome or trying to understand how their proteins express.
• 13:05
  And I think in mental health, very similarly, one of the things that's interesting is the ability to use big data tools, which is to say we've got access to lots more data.
• 13:14
  We can leverage much more powerful compute and perhaps some artificial intelligence to actually look at, okay, David.
• 13:22
  How do I help you manage your anxiety disorder?
• 13:25
  Because you're different than your brothers.
• 13:28
  Thanks for your health, John.
• 13:29
  And your, your anxiety sorts tied to your care talk projects, but doing, doing what I can.
• 13:35
  Again, family culture background is requires a lot more data.
• 13:39
  It's not like you do biology, but I think that would help my therapist figure out my challenges.
• 13:44
  Uh, I think it's really thinking about leveraging all of these technology tools to make sure that the general.
• 13:51
  recommendations are personalized to my specific problems, challenges, and opportunities.
• 13:56
  But I do think we're at the dawn of a different age and it's this divergence of biological tools, biological data and insights and big compute.
• 14:06
  Let me close out by following up on your, on your piece about the broader person and then also new technologies and new frontiers.
• 14:14
  So, uh, if you read the sociology journals, which I generally don't, but I did in preparation for this and understand what's the, what's the critique of.
• 14:21
  personalized medicine.
• 14:22
  So the concern is that we should kind of call it biological reductions.
• 14:27
  First, like, Hey, everything is taken down to your genes.
• 14:30
  And we're just going to engineer you and personalize it.
• 14:33
  You know, you lose all the context that you're describing.
• 14:35
  So that's on the one hand.
• 14:36
  So we need to bring that balance back on the other hand.
• 14:39
  Uh, you know, once we go beyond the genome, then there's the microbiome, which is all what lives in your, in your guts.
• 14:46
  And it's much more complicated.
• 14:48
  Um, actually then the, then the genome, but has this, uh, found locations that you do see companies, um, that are actually combining a microbiome and AI to understand what that means on a personalized basis.
• 15:00
  So where to come John's what I would say.
• 15:02
  I am less interested in exploring your gut and more in the general categories here, David.
• 15:07
  Sorry.
• 15:08
  All right.
• 15:08
  So you're interested in my, I'm losing track here.
• 15:10
  You're interested in my, my gut DOA and in my brain chemistry.
• 15:14
  In any case, that's it for yet another episode of Pure Chocolate, the talk today about personalized medicine.
• 15:20
  I'm David Williams, president of Health Wizard's Group.
• 15:22
  And I'm John Driscoll, the president of Walgreens Health.
• 15:24
  If you like what you heard or you didn't, please subscribe on your favorite service and leave us a review if you have a chance.