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Baird A, Westphalen C, Blum S, Nafria B, Knott T, Sargeant I, Harnik H, Brooke N, Wicki N, Wong‐Rieger D. How can we deliver on the promise of precision medicine in oncology and beyond? A practical roadmap for action. Health Sci Rep 2023; 6:e1349. [PMID: 37359405 PMCID: PMC10286856 DOI: 10.1002/hsr2.1349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Background Precision medicine (PM) is a form of personalized medicine that recognizes that individuals with the same condition may have different underlying factors and uses molecular information to provide tailored treatments. This approach can improve treatment outcomes and transform lives through favorable risk/benefit ratios, avoidance of ineffective interventions, and possible cost savings, as evidenced in the field of lung cancer and other oncology/therapeutic settings, including cardiac disease, diabetes, and rare diseases. However, the potential benefits of PM have yet to be fully realized. Discussion There are many barriers to the implementation of PM in clinical practice, including fragmentation of the PM landscape, siloed approaches to address shared challenges, unwarranted variation in availability and access to PM, lack of standardization, and limited understanding of patients' experience and needs throughout the PM pathway. We believe that a diverse, intersectoral multistakeholder collaboration, with three main pillars of activity: generation of data to demonstrate the benefit of PM, education to support informed decision-making, and addressing barriers across the patient pathway, is necessary to reach the shared goal of making PM an accessible and sustainable reality. Besides healthcare providers, researchers, policymakers/regulators/payers, and industry representatives, patients in particular must be equal partners and should be central to the PM approach-from early research through to clinical trials and approval of new treatments-to ensure it represents their entire experience and identifies barriers, solutions, and opportunities at the point of delivery. Conclusion We propose a practical and iterative roadmap to advance PM and call for all stakeholders across the healthcare system to employ a collaborative, cocreated, patient-centered methodology to close gaps and fully realize the potential of PM.
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Affiliation(s)
- Anne‐Marie Baird
- Lung Cancer Europe (LuCE)BernSwitzerland
- From Testing to Targeted Treatments (FT3) Program Team, The SynergistBrusselsBelgium
| | - C. Benedikt Westphalen
- Comprehensive Cancer Center Munich and Department of Medicine IIIUniversity Hospital, LMU MunichMunichGermany
| | - Sandra Blum
- From Testing to Targeted Treatments (FT3) Program Team, The SynergistBrusselsBelgium
- RocheBaselSwitzerland
| | - Begonya Nafria
- From Testing to Targeted Treatments (FT3) Program Team, The SynergistBrusselsBelgium
- Institut de Recerca Sant Joan de DéuBarcelonaSpain
- Innovation and Research Department, Hospital Sant Joan de Déu PgBarcelonaSpain
| | - Tanya Knott
- From Testing to Targeted Treatments (FT3) Program Team, The SynergistBrusselsBelgium
- Sarah Jennifer Knott (SJK) FoundationDublinRepublic of Ireland
| | | | - Helena Harnik
- From Testing to Targeted Treatments (FT3) Program Team, The SynergistBrusselsBelgium
- The SynergistBrusselsBelgium
| | - Nicholas Brooke
- From Testing to Targeted Treatments (FT3) Program Team, The SynergistBrusselsBelgium
- The SynergistBrusselsBelgium
| | - Nicole Wicki
- From Testing to Targeted Treatments (FT3) Program Team, The SynergistBrusselsBelgium
- The SynergistBrusselsBelgium
| | - Durhane Wong‐Rieger
- From Testing to Targeted Treatments (FT3) Program Team, The SynergistBrusselsBelgium
- Canadian Organization for Rare DisordersTorontoOntarioCanada
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Alqahtani AA, Ahmed MM, Mohammed AA, Ahmad J. 3D Printed Pharmaceutical Systems for Personalized Treatment in Metabolic Syndrome. Pharmaceutics 2023; 15:pharmaceutics15041152. [PMID: 37111638 PMCID: PMC10144629 DOI: 10.3390/pharmaceutics15041152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/20/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
The current healthcare system is widely based on the concept of “one size fit for all”, which emphasizes treating a disease by prescribing the same drug to all patients with equivalent doses and dosing frequency. This medical treatment scenario has shown varied responses with either no or weak pharmacological effects and exaggerated adverse reactions preceded by more patient complications. The hitches to the concept of “one size fits all” have devoted the attention of many researchers to unlocking the concept of personalized medicine (PM). PM delivers customized therapy with the highest safety margin for an individual patient’s needs. PM has the potential to revolutionize the current healthcare system and pave the way to alter drug choices and doses according to a patient’s clinical responses, providing physicians with the best treatment outcomes. The 3D printing techniques is a solid-form fabrication method whereby successive layers of materials based on computer-aided designs were deposited to form 3D structures. The 3D printed formulation achieves PM goals by delivering the desired dose according to patient needs and drug release profile to achieve a patient’s personal therapeutic and nutritional needs. This pre-designed drug release profile attains optimum absorption and distribution, exhibiting maximum efficacy and safety profiles. This review aims to focus on the role of the 3D printing technique as a promising tool to design PM in metabolic syndrome (MS).
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Affiliation(s)
- Abdulsalam A. Alqahtani
- Department of Pharmaceutics, College of Pharmacy, Najran University, Najran 11001, Saudi Arabia
| | - Mohammed Muqtader Ahmed
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Abdul Aleem Mohammed
- Department of Pharmaceutics, College of Pharmacy, Najran University, Najran 11001, Saudi Arabia
| | - Javed Ahmad
- Department of Pharmaceutics, College of Pharmacy, Najran University, Najran 11001, Saudi Arabia
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Erdmann A, Rehmann-Sutter C, Bozzaro C. Patients' and professionals' views related to ethical issues in precision medicine: a mixed research synthesis. BMC Med Ethics 2021; 22:116. [PMID: 34465328 PMCID: PMC8406914 DOI: 10.1186/s12910-021-00682-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Precision medicine development is driven by the possibilities of next generation sequencing, information technology and artificial intelligence and thus, raises a number of ethical questions. Empirical studies have investigated such issues from the perspectives of health care professionals, researchers and patients. We synthesize the results from these studies in this review. METHODS We used a systematic strategy to search, screen and assess the literature for eligibility related to our research question. The initial search for empirical studies in five data bases provided 665 different records and we selected 92 of these publications for inclusion in this review. Data were extracted in a spreadsheet and categorized into different topics representing the views on ethical issues in precision medicine. RESULTS Many patients and professionals expect high benefits from precision medicine and have a positive attitude towards it. However, patients and professionals also perceive some risks. Commonly perceived risks include: lack of evidence for accuracy of tests and efficacy of treatments; limited knowledge of patients, which makes informed consent more difficult; possible unavailability of access to precision medicine for underprivileged people and ethnic minorities; misuse of data by insurance companies and employers, potential of racial stigmatization due to genetic information; unwanted communication of incidental findings; changes in doctor-patient-relationship through focusing on data; and the problem that patients could feel under pressure to optimize their health. CONCLUSIONS National legislation and guidelines already minimize many risks associated with precision medicine. However, from our perspective some problems require more attention. Should hopes for precision medicine's benefits be fulfilled, then the ethical principle of justice would require an unlimited access to precision medicine for all people. The potential for autonomous patients' decisions must be greatly enhanced by improvements in patient education. Harm from test results must be avoided in any case by the highest possible data security level and communication guidelines. Changes in the doctor-patient relationship and the impact of precision medicine on the quality of life should be further investigated. Additionally, the cost-effectiveness of precision medicine should be further examined, in order to avoid malinvestment.
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Affiliation(s)
- Anke Erdmann
- Institute for Experimental Medicine, Medical Ethics Working Group, Kiel University (CAU), Kiel, Germany.
| | | | - Claudia Bozzaro
- Institute for Experimental Medicine, Medical Ethics Working Group, Kiel University (CAU), Kiel, Germany
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Amekyeh H, Tarlochan F, Billa N. Practicality of 3D Printed Personalized Medicines in Therapeutics. Front Pharmacol 2021; 12:646836. [PMID: 33912058 PMCID: PMC8072378 DOI: 10.3389/fphar.2021.646836] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/02/2021] [Indexed: 11/13/2022] Open
Abstract
Technological advances in science over the past century have paved the way for remedial treatment outcomes in various diseases. Pharmacogenomic predispositions, the emergence of multidrug resistance, medication and formulation errors contribute significantly to patient mortality. The concept of "personalized" or "precision" medicines provides a window to addressing these issues and hence reducing mortality. The emergence of three-dimensional printing of medicines over the past decades has generated interests in therapeutics and dispensing, whereby the provisions of personalized medicines can be built within the framework of producing medicines at dispensaries or pharmacies. This plan is a good replacement of the fit-for-all modality in conventional therapeutics, where clinicians are constrained to prescribe pre-formulated dose units available on the market. However, three-dimension printing of personalized medicines faces several hurdles, but these are not insurmountable. In this review, we explore the relevance of personalized medicines in therapeutics and how three-dimensional printing makes a good fit in current gaps within conventional therapeutics in order to secure an effective implementation of personalized medicines. We also explore the deployment of three-dimensional printing of personalized medicines based on practical, legal and regulatory provisions.
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Affiliation(s)
- Hilda Amekyeh
- Department of Pharmaceutics, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | | | - Nashiru Billa
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
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A Network-Based Mixed Methods Approach to Analyze Current Perspectives on Personalized Oncological Medicine in Austria. J Pers Med 2020; 10:jpm10040276. [PMID: 33322735 PMCID: PMC7768434 DOI: 10.3390/jpm10040276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 12/15/2022] Open
Abstract
Personalized medicine (PM) to tailor healthcare (HC) to the individual, is a promising but challenging concept. So far, no study exists investigating stakeholders’ perspectives on PM in oncology in Austria potentially hindering implementation, which was the aim of this study. We performed semi-structured interviews among experts (n = 14) and cancer patients (n = 2) of the Vienna General Hospital and the Medical University of Vienna and analyzed them by a mixed methods network theoretical approach. Study results show a great variety of topics addressed by the interviewees. Clear differences in the topic selection between patients and experts could be observed. Patient-doctor relationship was the most prominent theme among experts, whereas HC systems and public health in PM was more relevant for the patients. Although promising new molecular pathology methods were explicitly mentioned, the experts believed that their practical implementation and the implementation of PM in standard care will take a long time in Austria. A variety of concerns regarding PM were mentioned by the experts, including communication issues and knowledge gaps. Besides important insights into the current situation of PM in Austria, the study has shown that network theory is a powerful tool for analyzing qualitative interview data.
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Di Paolo A, Sarkozy F, Ryll B, Siebert U. Personalized medicine in Europe: not yet personal enough? BMC Health Serv Res 2017; 17:289. [PMID: 28424057 PMCID: PMC5395930 DOI: 10.1186/s12913-017-2205-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/30/2017] [Indexed: 12/17/2022] Open
Abstract
Background Personalized medicine has the potential to allow patients to receive drugs specific to their individual disease, and to increase the efficiency of the healthcare system. There is currently no comprehensive overview of personalized medicine, and this research aims to provide an overview of the concept and definition of personalized medicine in nine European countries. Methods A targeted literature review of selected health databases and grey literature was conducted to collate information regarding the definition, process, use, funding, impact and challenges associated with personalized medicine. In-depth qualitative interviews were carried out with experts with health technology assessment, clinical provisioning, payer, academic, economic and industry experience, and with patient organizations. Results We identified a wide range of definitions of personalized medicine, with most studies referring to the use of diagnostics and individual biological information such as genetics and biomarkers. Few studies mentioned patients’ needs, beliefs, behaviour, values, wishes, utilities, environment and circumstances, and there was little evidence in the literature for formal incorporation of patient preferences into the evaluation of new medicines. Most interviewees described approaches to stratification and segmentation of patients based on genetic markers or diagnostics, and few mentioned health-related quality of life. Conclusions The published literature on personalized medicine is predominantly focused on patient stratification according to individual biological information. Although these approaches are important, incorporation of environmental factors and patients’ preferences in decision making is also needed. In future, personalized medicine should move from treating diseases to managing patients, taking into account all individual factors. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2205-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Antonello Di Paolo
- Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Pisa, Via Roma 55, 56126, Pisa, Italy.
| | | | - Bettina Ryll
- Melanoma Patient Network Europe; Evolutionary Biology Centre, Uppsala University, Uppsala, Sweden
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria.,Area of Health Technology Assessment, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
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Budin-Ljøsne I, Harris JR. Patient and interest organizations' views on personalized medicine: a qualitative study. BMC Med Ethics 2016; 17:28. [PMID: 27178188 PMCID: PMC4866041 DOI: 10.1186/s12910-016-0111-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/09/2016] [Indexed: 01/07/2023] Open
Abstract
Background Personalized medicine (PM) aims to tailor disease prevention, diagnosis, and treatment to individuals on the basis of their genes, lifestyle and environments. Patient and interest organizations (PIOs) may potentially play an important role in the realization of PM. This paper investigates the views and perspectives on PM of a variety of PIOs. Methods Semi-structured telephone interviews were conducted among leading representatives of 13 PIOs located in Europe and North-America. The data collected were analysed using a conventional content analysis approach. Results The PIO representatives supported the realization of PM but feared that many financial, structural and organizational challenges may delay its realization. They encouraged strategies to modernize drug licencing mechanisms, develop research and data sharing infrastructures, and educate patients and health care professionals in PM. Notably, they emphasized the importance of developing PM in an equitable way and taking into consideration the patients’ needs, values and personal situation. Despite varying levels of awareness regarding PM, the PIO representatives expressed willingness to engage in the PM agenda and recommended that PIOs work closely with policy-makers to design PM in a way that truly addresses the needs and concerns of patients. Conclusions PIOs have the potential to become central drivers of the PM agenda. Collaborations should be further developed between PIOs, researchers, drug developers and health care authorities.
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Affiliation(s)
- Isabelle Budin-Ljøsne
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, P.O Box 1130, Blindern, NO-0318, Oslo, Norway. .,Norwegian Cancer Genomics Consortium, kreftgenomikk.no, Oslo, Norway.
| | - Jennifer R Harris
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
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Witt E. [The digital looking glass: ethical aspects of large data collections]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58:853-858. [PMID: 26092164 DOI: 10.1007/s00103-015-2187-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The increase in the quality and quantity of health-related data stored and analyzed in different contexts is leading to new challenges to the protection of privacy. To demonstrate the major challenges, a description of the main categories of large data collections is given, followed by a short analysis of their current data security demands. The rising possibilities and risks that emerge from the increasing potential of big data methods of aggregation and the analysis of the huge amount of health-related data are discussed in light of the question: should new ways be found to further ensure the right to privacy?
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Affiliation(s)
- Elke Witt
- TMF - Technologie- und Methodenplattform für die vernetzte medizinische Forschung e. V., Charlottenstraße 42/Ecke Dorotheenstraße, 10117, Berlin, Deutschland.
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Egalite N, Groisman IJ, Godard B. Personalized medicine in oncology: ethical implications for the delivery of healthcare. Per Med 2014; 11:659-668. [PMID: 29764052 DOI: 10.2217/pme.14.53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
While personalized medicine brings benefits for the treatment of cancer, there are still key ethical issues at stake in developing personalized medicine in oncology. We propose an ethical analysis of personalized medicine in oncology that highlights the particularities of cancer care, critically assesses the scientific advances behind personalized medicine in oncology and emphasizes fairness in resource allocation in the delivery of personalized healthcare. This allows for a broader understanding of the real impacts on both recipients and the healthcare system.
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Affiliation(s)
- Nathalie Egalite
- Omics-Ethics Research Group, Department of Preventive & Social Medicine, Public Health School, University of Montreal, C.P. 6128, succ. Centre-ville, Montreal, QC, H3C 3J7, Canada
| | - Iris Jaitovich Groisman
- Omics-Ethics Research Group, Department of Preventive & Social Medicine, Public Health School, University of Montreal, C.P. 6128, succ. Centre-ville, Montreal, QC, H3C 3J7, Canada
| | - Beatrice Godard
- Omics-Ethics Research Group, Department of Preventive & Social Medicine, Public Health School, University of Montreal, C.P. 6128, succ. Centre-ville, Montreal, QC, H3C 3J7, Canada
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