Precision medicine treats patients individually

By Jean Robillard / Guest Column

Medicine is rapidly changing and health care providers nationwide are working to stay ahead of the curve by bringing the newest, most beneficial and most accurate medicine to patients and their families.

Until recently, most medical treatments have been designed for the general patient population, with the result of this nonspecific approach being treatments that work well for some patients and not for others.

Precision medicine, on the other hand, is an innovative approach that takes into account individual differences in people’s genes, environments and lifestyles. With this new knowledge, health care providers are able to tailor treatment, improve patient health outcomes and ultimately reduce health care costs.

President Barack Obama announced the Precision Medicine Initiative — a $215 million investment in research to revolutionize how providers improve health and treat disease — in his 2015 State of the Union address. Health care providers across the state are also recognizing the importance of having easy access to genetic and genomic services by qualified health professionals for Iowans.

Genetic and genomic services make precision medicine possible by using a patient’s genetics, through diagnostic testing and other means, to determine the best and most appropriate therapies. For example, University of Iowa scientists have determined that a pharmacogenetic test can show, through DNA analysis from a blood sample, if a patient metabolizes the blood-thinner clopidogrel — 30 percent of patients don’t, making it ineffective. By knowing this information in advance, physicians can select the appropriate therapy for a patient.

Precision medicine relies on a tight connection to the services that genetic counselors provide for patient education and advocacy. Certified genetic counselors have specialized graduate training in medical genetics and counseling. As members of an interdisciplinary health care team, they convey complex and difficult-to-comprehend information such as medical history, test options and test results in easy-to-understand terms that empower patients to make informed decisions about their care.

They also provide support throughout the health care process, working with providers and patients to coordinate referrals to appropriate specialists, help patients understand and reach decisions about a treatment plan, explain the meaning of the medical science involved and more.

The goal of genetic counseling is to help patients better understand their conditions. While a physician also can order, analyze and discuss genetic tests, genetic counselors alleviate some of the burden from providers who may not have the time for in-depth, focused consideration of every patient’s situation. By spending time with patients, genetic counselors not only help target appropriate treatment and prevention, but also help enhance patient satisfaction and the likelihood of patient adherence to treatment and care management plans.

Health care reform and the rapidly expanding role of genomics in health care decisions are increasing the demand for qualified genetic professionals. It’s a growing field, and providers throughout Iowa are actively recruiting more genetic counselors, especially in cancer, obstetrics, cardiology and neurology. State licensure of certified genetic counselors, which already exists in 21 states, helps ensure that the health care system has a qualified workforce to provide genetic and genomic services for the growing number of patients and families who need them.

Personalized approaches enable more precise health care delivery and have the potential to improve outcomes and delivering significant other benefits while reducing waste of resources. Scientists at the Iowa Institute of Human Genetics are actively working with the state’s genetic counselors to implement licensure of genetic counselors, and UI Health Care looks to be supportive of this legislation.

UI Health Care, alongside many of our health care colleagues throughout the state, is taking this next step in an effort to exceed the expectations of patients and ensure the future of cutting-edge, high-efficiency and low-cost health care through these emerging approaches to disease treatment and prevention.

Jean Robillard is vice president for medical affairs with University of Iowa Health Care.