Personalised medicine

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  • A quick win in personalised medicine could be in the area of rare inherited disorders, of which most are life-threatening or seriously debilitating. Currently, 6000-8000 rare inherited disorders are known and the genetic basis of around halve has been resolved. About a thousand are currently treatable and taken together all rare inherited disorders place a major burden on Europe’s health care systems.

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  • The successful integration of omics-based personalised medicine into clinical practice does not only require the demonstration of its clinical utility and cost-effectiveness but also the development of processes so that the relevant information is available to the correct health practitioner at the appropriate time. This is particularly important as the routine availability of whole genome sequences becomes a reality. In conjunction with education, research in clinical bioinformatics needs to be undertaken as to how such vast data can be appropriately presented.

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  • Europe is facing multiple challenges in the health sector and in health research. In the health sector, ageing population, failures of blockbuster approaches, increasing costs of healthcare and concomitant cost containment for healthcare are just a few of the obstacles to face. In health research, there is a need to better understand the mechanisms of diseases, break barriers across disciplines, and translate research results into clinical practice. Personalised medicine is an emerging field that promises to bring radical changes in healthcare.

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  • The sequencing of the human genome together with the development and implementation of new high throughput technologies (so called “omics”) are enhancing our knowledge on human health and disease and have already, and will continue, to provide a sound foundation for personalised medicine.

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  • Only recently have Indigenous Peoples in North America begun to revitalize traditions openly and without fear of persecution. We must remember that it is only since the 1970s that legal bans on healing/religious ceremonies such as the Sundance have been lifted. This Indigenous literature is often found outside of academia and within Native organizations and their resource libraries, research reports (founded either by government or community bodies) and Web sites such as American Indian Physicians Association, the World Health Organization and Pan American Health Organization.

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  • Take molecular genetics and bioinformatics for example; these are perhaps two of the most exciting areas of biology and are beginning to have an impact on other areas of medical therapeutics such as cancer and diabetes, and provide a signpost to ‘personalised medicine’. Yet recent genome wide association (GWAS) studies of large samples, have demonstrated that in schizophrenia around 1000 or more genetic variants of low penetrance may be implicated in the heritability of schizophrenia.

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  • Integration of the patient electronic health record (EHR) with publicly accessible information creates new opportunities and challenges for clinical research and patient care. For example, one challenge is that the complexity of the information provided to the clinician must not impair the clinician’s ability to accurately and rapidly prescribe drugs that are safe and effective for a specific patient, and covered by the patient’s insurance provider.

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  • The workshop "Stratification biomarkers in personalised medicine" that was held at the European Commission in Brussels on 10th and 11th June 2010 brought together experts from different fields and perspectives in order to stimulate an open discussion about the evolution of this rapidly expanding area, in which biomarkers are used to adapt therapies to the characteristics of patient populations.

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  • Reliable gene-lifestyle interaction studies will yield important evidence for the shaping of personalised healthcare. Studies need statistical power with adequate environmental exposures and lifestyle heterogeneity to obtain reliable evidence on the interplay between nurture and nature. Europe has a historic strength in large epidemiological studies but technology development and implementation is needed to better ascertain environmental exposure and dietary heterogeneity.

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  • Overwhelming demand from developers slowed the Government’s approval process which in turn slowed development considerably. However, the banking industry has adjusted to the new federal regulatory requirements, improved their lending position by removing troubled loans and increasing capital and placed themselves in a position to loan once again. Banks have become more aggressive and competition for new loans is tremendous. Because of the strong apartment market, conventional financing for new communities is becoming more readily available.

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  • Despite advances in pharmacology, not all patients respond favourably to drugs. A proportion of patients under therapy don't benefit from their treatment or experience an adverse reaction to the medication. However, progress in the understanding of disease mechanisms and drug actions are opening opportunities to match therapies to patient populations, and thus pave the way towards a more personalised medicine.

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  • Genomics and other "omics” technologies have largely contributed to the identification and the development of biomarkers. Due to genetic causes of variability among individuals, genotyping and gene expression analysis are indeed key elements of the emergence of personalised medicine. However, genomic technologies have limitations (functional significance of genetic variants, false negatives, etc) and cannot encompass all approaches for the development of stratification biomarkers.

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