Q: Could you please briefly define precision medicine for us?
Victor Dzau: Precision Medicine, previously called personalized medicine, was defined as the form of medicine that tailors treatment for individuals based on their own characteristics and needs. I think precision medicine and health takes it one step further through more accurate testing, and providing precise medicine to an individual, while incurring less side effects, lower costs, fewer tests and obtaining better outcomes .
Q: Why does precision medicine matter, and why do you think it ranks as one of the world’s most important healthcare issues?
Victor Dzau: Precision medicine is important because it represents an advance. When you think about where we are in healthcare today, we have lots of great technology in medicine but it’s highly fragmented. If you take an average patient who comes into the system, they undergo testing and some of these tests are somewhat empirical until you have the right answer. Then you give that person treatment, usually medicine. The evidence of the efficacy of this medicine is based on clinical trials, which simply means if you take a population randomized with control, that is better than control, it doesn’t mean everybody is going to respond to it, but the majority will.
Q: Why do you find this area of research so rewarding and interesting?
Victor Dzau: As physicians, we always believe we’re practicing personalized medicine. When I look at you as my patient, I use my best judgment to meet your needs. Where precision medicine takes the next step is that it gives a physician the tools to determine your diagnosis without having to do a lot of different tests, then determine the medication most likely to provide the best benefits for you precisely. That fulfills the desire to be a good doctor. What’s also exiting about precision medicine is the tremendous advances in science and technology. You can sequence an individual’s genome for less than a thousand dollars. That scientific advancement is very important for us to be able to say that now we have the tools to be able to do precision medicine.
Q: In general, what has the response been from patients towards precision medicine?
Victor Dzau: In general, patients are quiet excited. They say: ‘If you can do less tests, I’m going to get the best medicine without side effects, it’s going to save me a lot of time and possibly money, and still give me a better outcome, it’s a great thing’. Some patients may be concerned that if we have their genetic information their privacy is compromised. They worry their information is going to be used inappropriately, or wonder who owns that information. These are the questions they should be asking.
Q: What about police makers? Do policy makers embrace precision medicine? Or is there some resistance?
Victor Dzau: I think policy makers embrace precision medicine. Most of them believe that it is better for health and medicine, but I think the struggle is in trying to work the right policy for precision medicine.
Q: From your point of view, what are the main recommendations coming out of your research?
Victor Dzau: We feel precision medicine holds great promise. The challenge is how to get to that ultimate point where it becomes everyday practice, where technology is going to result in an improvement in outcomes and also cost effectiveness. In that context, we found there are a number of areas you need to address in order to make this happen. As science moves forward, we have to highlight the evidence to support the idea that precision medicine is better than what we have. How do you generate evidence that includes outcomes and even a cost analysis? We also have to ask how we implement this, how do you make sure that people know how to use it, and that they are in fact incentivized to use it, and of course create treatment guidelines to use it properly. There is also the issue of privacy. How do you make sure information is shared and understand who owns the data? In other words, how do you protect a patient’s privacy? Finally we have to consider patient and public engagement. You have to educate the public, and make sure that people are engaged in determining how precision medicine is being used.
Q: How does WISH contribute to this research?
Victor Dzau: WISH as they say is not a meeting; it is in fact a convening entity which will bring people together around important topics. WISH brings together global experts to think about what is next. And what is next means that you begin to think about recommendations, particularly around policy, and you try to move it forward. And I think that is critically important because if we think about precision medicine, we think about how to get the best minds together to find out the ways we can address issues such as evidence generation, policy implementation, patient engagement or data sharing, to move forward. Perhaps what is more important is that we understand these challenges. Only then can we think about what areas to make policy changes in. The policies will then enable us to overcome the challenges and ultimately make precision medicine effective.