Personalized preventive medicine

Much research and media attention have focused on personalized medicine.  The National Cancer Institute defines personalized medicine as “a form of medicine that uses information about a person’s genes, proteins, and environment to prevent, diagnose, and treat disease.”  Although this definition includes prevention, much of the focus of personalized medicine has been on treatments, with a focus on genetics as the key determinants of a patient’s predicted response.  President Obama’s Precision Medicine Initiative, for example, which this month is 12 months old, focuses on tailoring treatments to the individual, with little mention of personalizing preventive medicine modalities.

Per the CDC’s Preventive Care site, preventive care includes both health promotion and disease screening.

• Health promotion includes proper immunizations, managing one’s weight, being physically active, eating a healthy diet, not smoking, drinking moderate amounts of alcohol, wearing seat-belts/helmets, getting enough rest, surrounding oneself with family and friends, driving safely, managing stress, and, in general, living what most would agree is a healthy lifestyle. These are activities that often do not require medical personnel–they are often individually guided, or can be policy-related, such through laws requiring seatbelt use, taxing cigarettes, and restricting the availability of sugary drinks at schools.
• Disease screening includes health services like mammograms, colonoscopies, Pap tests and regular tests of blood pressure and cholesterol.  These services generally involve medical personnel.

The CDC site also includes a tool you can use to identify the recommended disease screening services by age and gender, reflecting a basic level of preventive care personalization by these two factors.  A Health Affairs article provides a more detailed overview of preventive health modalities and the potential cost-benefit for them.

A recent NY Times post highlights the value of personalized preventive medicine:  it summarizes recent studies that show the way we absorb and metabolize various foods is highly variable and thus dietary advice is not one-size-fits-all.  Some of the factors that determine an individual’s response to various foods include demographics, genetic makeup, gut bacteria, body type, medications, family history, lifestyle, and chemical exposures. A video summary of one study featured, “Personalized Nutrition by Prediction of Glycemic Responses” is available here.  Although recently we have learned more about the ideal “dosing” of exercise for the population, the recommendations are not personalized.

One of the more controversial attempts at personalizing preventive care was the U.S. Preventive Services Task Force guidelines on mammography.  After review of existing research, the Task Force decided against recommending mammography for some women in their 40s.  The personalized preventive medicine approach also took into account family history: the Task Force recommended that women with mothers or sisters with a history of breast cancer may benefit more from screening in their 40s.