“It is far more important to know what person the disease has than what disease the person has.”
—Hippocrates de Cos (460 BC – 370 BC)
In his State-of-the-Union address on January 20, 2015, President Obama announced the launching of a $215 million Precision Medicine Initiative (PMI). One of the projects funded by PMI aims to integrate demographic, clinical, environmental, and genomic data, from a million or more American volunteers, to “understand the complex mechanisms underlying a patient’s health, disease, or condition, and to better predict which treatments will be most effective.”
While medicine moves increasingly toward more standardized care, the concept of precision medicine examines an individual’s genetic and environmental variations in disease prevention and treatment strategies. Recent developments in perioperative medicine such as the Perioperative Surgical Home or the Enhanced Recovery After Surgery program emphasize the formation of new care pathways and protocols. One of the aims of these programs is to decrease variability of care at the systemic and practitioner level. Precision medicine may provide the counterbalance to bring back a more individualized approach to patient care, based on each patient’s inherent variability.
The Department of Anesthesiology & Perioperative Medicine at UCLA is actively engaged in leading research centered on precision medicine and personalized care in the perioperative setting. The ambitious goal is to integrate care redesign processes and precision health concepts to improve human health, one patient at a time.
The premise of precision medicine is simple: Each human being harbors unique differences relating to disease susceptibility and drug metabolism. Therefore, diagnostic and therapeutic plans ought to be individually tailored based on these specific differences. This is far from a revolutionary concept as Hippocrates emphasized more than 2,000 years ago the importance of a personalized approach in medicine.
With the completion of the Human Genome Project, it became theoretically possible to tailor treatment to the precise molecular variations in individuals, potentially revolutionizing healthcare. The best representation of achievements by the Human Genome Project in medicine is the finding of an enormous number of associations between single-nucleotide-polymorphisms (SNPs) and various traits. The genome-wide association studies catalog maintained jointly by the National Human Genome Research Institute and the European Bioinformatics Institute lists a total of 2,361 studies with 16,809 SNP-trait associations where only the most highly significant studies, with p values less than 5X10-8, are included*.
While genomic discoveries have been made in many major aspects of medicine – including cardiovascular disease, digestive disease, nervous system disease, immune system disease, metabolic disease and cancer – the field of anesthesiology has not yet benefited clinically from such discoveries. Why hasn’t this deluge of genomic data translated into clinical practice in anesthesiology? The simple answer may be that the relationship between genotype and phenotype is far more complicated than previously thought, particularly in variability of pharmacologic response – a key concern in anesthesiology. Many layers of complexity have yet to be elucidated before we can harness the predictive power of genomic medicine into clinical anesthesia practice.