Genomics - The Future of Healthcare

Americans suffer a tremendous burden of poor health and disease. The incidence of most chronic degenerative diseases has increased in virtually every age group during almost every decade of the past 50 years. Tragically, a great deal of this suffering is unnecessary—as a large body of therapeutic knowledge is not being applied. In the past, much of this knowledge base was largely the province of natural medicine, now variously recognized as alternative, orthomolecular, complementary, collaborative, functional, and integrative medicine. This medicine looks at each individual as unique, utilizes therapies that support the body’s innate healing processes (rather than therapies that take over or replace body functions), and fully engages the patient in his or her own healing process.

 

We have much to be grateful for in conventional medicine - almost miraculous advances  in acute illness, trauma and life-threatening disease accomplished through dedication, intense research, and a huge investment of our country’s resources. Key to this advancement has been standardization of diagnosis, of therapy and, unfortunately, of people. Conventional medicine has developed standardized therapies for standard diagnoses for generic patients that are sometimes curative, often highly effective in symptom relief, but not very effective in promoting health and utterly incapable of recognizing how truly different each of us is, starting at the cellular level. Worse, the lack of recognition of each patient’s unique biochemistry is a primary cause of the huge incidence of adverse drug reactions from appropriately prescribed medications.

 

We are entering a new era of healthcare. The decoding of the human genome is allowing us to progressively and accurately map out more and more of each individual’s unique biochemistry. This new understanding can take us in divergent directions. One path being pursed by most of the pharmaceutical industry, is the creation of designer drugs that treat (relieve symptoms of) disease and require life-long use.

 

Alternatively, our emerging understanding of the human genome can be used to provide healthcare that fully appreciates the unique biochemistry of each individual, that provides a lifestyle guide for maximum health, and that offers interventions tailored to optimize physiological function, improve resilience to environmental challenge, and promote wellness. Furthermore, understanding the patient’s biochemical individuality will facilitate much more effective integration of conventional and CAM interventions.

 

When conventional drugs are necessary, understanding the activity (or inactivity) of the patient’s specific detoxification pathways will allow much more accurate and safe prescribing and dosing. Equally important, genomic testing can be used to improve clinical outcomes, such as predicting responsiveness to specific chemotherapeutic agents. In a recent study, V. Cohen, et al showed that genetic variations in methylenetetrahydrofolate reductase (MTHFR) correlated with clinical response to 5-FU of patients with advanced colon cancer.[i] Being able to predict responsiveness and probability of toxic response will fundamentally change how medicine is practiced.

 

 

 

 

Of greater significance, however, is the potential of these tools for solving the healthcare crisis and facilitating our provision of more advanced patient guidance and care. Understanding a person’s genetics, environmental toxin exposure, nutritional status and lifestyle, we can predict the diseases an individual will likely develop, and, if a disease is already present, the optimal pathway for its reversal. For each person, we can design an individualized health guidebook that clearly delineates his or her specific areas of greatest vulnerability, and the optimal diet, lifestyle, and natural health products that will maximize life and health span. Where genetic susceptibility exists, we can safely and effectively use nutritional and herbal therapies, sometimes at high dosages, to normalize function, thus improving health and preventing disease. Included in this personalized health guidebook could also be a listing of drugs requiring special precautions due to increased risk of adverse reactions.

 

Also encouraging is the emerging research showing that genomic testing may increase patient lifestyle change compliance. In an interesting recent study, A J Wright, et al found that “learning of a genetic predisposition to nicotine dependence may increase desire for effective cessation methods, but may undermine the perceived importance of willpower in stopping smoking.”[ii] This somewhat contradictory result appears to imply that genomic susceptibility is indeed an effective motivation, although the patient may feel less in control.

 

The age of personalized medicine is upon us.