What Obama’s Plan for ‘Precision Medicine’ Really Means

The president wants to help develop new, more effective drugs.

Prescription Medicine
National Journal
Sam Baker
Jan. 20, 2015, 4:12 p.m.

Pres­id­ent Obama used his State of the Uni­on ad­dress Tues­day to launch a new ini­ti­at­ive that would use the hu­man gen­ome to build bet­ter med­ic­al treat­ments.

Obama called it the “Pre­ci­sion Medi­cine Ini­ti­at­ive” — so what’s pre­ci­sion medi­cine, any­way?

In short, it’s one of the most prom­ising and ex­cit­ing fields of med­ic­al re­search. Pre­ci­sion medi­cine, also known as “per­son­al­ized medi­cine,” is about the know­ledge we’ve gained by se­quen­cing the hu­man gen­ome. It’s the ef­fort to turn that know­ledge in­to bet­ter, more ef­fect­ive medi­cines.

“I want the coun­try that elim­in­ated polio and mapped the hu­man gen­ome to lead a new era of medi­cine — one that de­liv­ers the right treat­ment at the right time,” Obama said. “In some pa­tients with cyst­ic fibrosis, this ap­proach has re­versed a dis­ease once thought un­stop­pable.”

The ap­proach is built largely on sci­ence’s im­proved un­der­stand­ing of ge­net­ics. The think­ing, roughly, is that doc­tors will be able to look to pa­tients’ genes to see wheth­er they’re at in­creased risk for cer­tain con­di­tions — mean­ing doc­tors could try to to pre­vent those dis­eases from de­vel­op­ing, or be on the lookout to treat them early if they do de­vel­op.

And by bet­ter un­der­stand­ing each pa­tient’s in­di­vidu­al ill­ness, doc­tors can bet­ter tail­or the right dose of the right medi­cine, at the right time.

Fran­cis Collins, the dir­ect­or of the Na­tion­al In­sti­tutes of Health, is a lead­ing ad­voc­ate for more per­son­al­ized medi­cine. Here’s how he de­scribed it in an in­ter­view last fall:

“If I got a dia­gnos­is of can­cer today, I would want that can­cer to be com­pletely se­quenced, to see what muta­tions are there that are driv­ing those cells to grow when they shouldn’t, and then to be able to use that in­form­a­tion to pick from the cur­rent menu — which is grow­ing rap­idly — of mo­lecu­larly tar­geted drugs.”

Es­pe­cially in terms of ac­tu­ally de­vel­op­ing medi­cines, it’s still a young field. Sci­ent­ists are learn­ing a lot, very quickly, about the un­der­ly­ing ge­net­ic causes of many dis­eases. But the busi­ness of trans­lat­ing that know­ledge in­to more tar­geted treat­ments is still just get­ting star­ted.

That’s what Obama pro­posed jump-start­ing in the State of the Uni­on.

“To­night, I’m launch­ing a new Pre­ci­sion Medi­cine Ini­ti­at­ive to bring us closer to cur­ing dis­eases like can­cer and dia­betes — and to give all of us ac­cess to the per­son­al­ized in­form­a­tion we need to keep ourselves and our fam­il­ies health­i­er,” he planned to say, ac­cord­ing to the pre­pared speech.

He might even be able to find some bi­par­tis­an sup­port, de­pend­ing on the de­tails of the plan. (The pre­pared text didn’t of­fer any more in­form­a­tion.)

The House En­ergy and Com­merce Com­mit­tee, chaired by Rep. Fred Up­ton, is in the midst of an am­bi­tious pro­ject to fig­ure out a bet­ter way to test and ap­prove new drugs. Ahead of Tues­day’s speech, Up­ton praised the co­oper­a­tion he has re­ceived from top Health and Hu­man Ser­vices of­fi­cials, in­clud­ing Sec­ret­ary Sylvia Math­ews Bur­well.

Up­ton’s and Obama’s ini­ti­at­ives aren’t the same — Up­ton’s is about the reg­u­la­tion of new drugs, while the pres­id­ent’s is about their de­vel­op­ment. But, of course, those two things go hand in hand.

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