Precision medicine
see Precision medicine for glioblastoma.
According to the National Institutes of Health (NIH), precision medicine is “an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person.” This approach will allow doctors and researchers to predict more accurately which treatment and prevention strategies for a particular disease will work in which groups of people. It is in contrast to a “one-size-fits-all” approach, in which disease treatment and prevention strategies are developed for the average person, with less consideration for the differences between individuals.
Although the term “precision medicine” is relatively new, the concept has been a part of healthcare for many years. For example, a person who needs a blood transfusion is not given blood from a randomly selected donor; instead, the donor’s blood type is matched to the recipient to reduce the risk of complications. Although examples can be found in several areas of medicine, the role of precision medicine in day-to-day healthcare is relatively limited. Researchers hope that this approach will expand to many areas of health in coming years.
There is a lot of overlap between the terms “precision medicine” and “personalized medicine.” According to the National Research Council, “personalized medicine” is an older term with a meaning similar to “precision medicine.” However, there was concern that the word “personalized” could be misinterpreted to imply that treatments and preventions are being developed uniquely for each individual; in precision medicine, the focus is on identifying which approaches will be effective for which patients based on genetic, environmental, and lifestyle factors. The Council therefore preferred the term “precision medicine” to “personalized medicine.” However, some people still use the two terms interchangeably.
Pharmacogenomics is a part of precision medicine. Pharmacogenomics is the study of how genes affect a person’s response to particular drugs. This relatively new field combines pharmacology (the science of drugs) and genomics (the study of genes and their functions) to develop effective, safe medications and doses that will be tailored to variations in a person’s genes.
Precision medicine may also link the right therapy to the right patient including new approaches to Traumatic brain injury classification beyond the Glasgow coma scale or anatomical phenotyping-incorporating new genetic and physiologic approaches. Therapeutic breakthroughs may also come from alternative approaches in clinical investigation (comparative effectiveness, adaptive clinical trial design, use of the electronic medical record, big data). The full continuum of care must also be represented in translational studies, given the important clinical role of pre-hospital events, extra-cerebral insults in the ICU, and rehabilitation. Traumatic brain injury research from concussion to coma can cross-pollinate and further advancement of new therapies. Misconceptions can stifle/misdirect TBI research and deserve special attention. Finally, Kochanek et al. synthesize an approach to deliver therapeutic breakthroughs in this golden age of TBI research 1).