Few areas of healthcare have been the subject of more hype, and achieved less genuine good, than personalised medicine. Companies are eager to track your biomarkers or supply a personalised nutrition plan – all for a healthy fee, of course – but truly useful personalised medicine is still a long way off.
The idea remains a good one, though. We all differ: in our genetics, in our microbiomes, in every detail of our bodies. And our quirks can make a big difference to our health.
Two stories this week exemplify this. Almost all of us will be infected by the Epstein-Barr virus at some point in our lives, but, as we report here, genetic variants mean some of us are less able to expel it from our bodies. This may help explain why the virus is harmless to most people, but may be behind autoimmune conditions such as multiple sclerosis in some. Likewise, some people are resilient to the misfolded proteins that would otherwise cause Alzheimer’s disease.
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It is vital to identify the people whose bodies are most likely to respond to a treatment
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Understanding these disease processes – and ultimately intervening in them – requires us to understand the complexity and diversity of human biology. It means gathering huge volumes of data on everything from people’s DNA to their immune systems, and figuring out the mechanisms at work in different people.
It also means designing clinical trials of new treatments with greater care. No longer can we simply give the same treatment to a large group of people with a condition, because their responses may well vary enormously. Instead, it is vital to identify the people whose bodies are most likely to respond to the treatment.
We have already done this in one area of medicine: cancer. While we label all kinds of growths as “cancer”, the reality is that they are distinct and require different treatment protocols. There is no one “cure for cancer”, but many.
These are big challenges, but if we want to make progress in treating conditions like Alzheimer’s and multiple sclerosis, it is time for us to meet them.