Medicine is changing. In Australia a baby born today will live, on average, for 90 years or more. The common infectious killer-diseases have been eliminated. The treatment of cancer is becoming a success story, far different from the horror with which cancer was viewed by my parents and their generation in the 1950s. Heart disease still kills people, but often in their 80s and not their 50s. The new medicine will put together information from a person’s DNA, their environment and diet, their habits and choices, and meld this into the new medicine, a medicine that will try to use this knowledge to prevent disease. That is the message of the analysis of the road map for “The future of precision medicine in Australia” report recently launched by the Australian Learned Academies of Australia (ACOLA).
In many clinical situations, precision medicine will improve treatment for an individual (for instance, identifying the mutations that cause a cancer to guide which of a range of possible therapies is most likely to succeed). This will not change a patient’s experience dramatically, as the patient will still be seen in a clinical environment where existing resources will be combined with precision medicine. The obvious places to start to use precision medicine are for rare diseases and cancer.
More significant is the potential to read each person’s genome in a matter of days, at low cost, and obtain information on anyone’s disease-associated gene variants. Precision medicine will turn into personalised medicine, applying these new technologies to an individual, identifying health risks and suggesting early interventions to prevent disease. The crucial importance of precision medicine is its long-term potential to offer better health by preventing common diseases such as dementia, cancer, diabetes and mental illness, based on precise person-specific knowledge.
In the new world of precision medicine, the general practitioner will assume a new and crucial role. Those in primary health care must be ready to understand, interpret and implement these findings in the community. Patients must be willing to accept this knowledge as part of health care. There will be particular challenges in offering precision medicine to those who have most to gain, such as Indigenous Australians and those living in rural settings.
Precision medicine raises ethical issues. While a strong case can be made for the introduction of genomics and precision medicine into health care, this must be done with full community discussion and support. Many of the benefits of precision medicine will involve the aggregation of personal information into big data, and the community will expect guarantees that data on individuals, such as their genome and its implications for health, are secure and will not be accessed other than in a prescribed way by health professionals. Genomic data have implications for families as well as individuals, meaning that in some cases counselling and consent will be needed before testing commences.
The applications of precision medicine are transformative; they will lead to new opportunities, end old practices and change the landscape of health care. In a rapidly moving environment, we must remain flexible and not become committed to one technology, but be ready to compare many. The rate of progress in designing effective and inexpensive instrumentation is remarkable; the cost of a human whole genome sequence is now less than US$1,000 and will soon be much less again.
We must ensure that the benefits that will come from a national commitment to cost-effective precision medicine will not be limited to health but will also contribute by extension to areas such as agriculture, veterinary medicine, aquaculture, defence and sport. This commitment will contribute to the government’s national policy to encourage technological innovation and to link university, hospital and medical research institute efforts more closely to biotechnology investment, through small and medium-sized enterprises, and to the national innovation policy. Our health and agriculture sectors are advanced by international standards, Australia is well positioned to take advantage of these opportunities. With careful planning and approaches, precision medicine technologies and applications can provide exciting technological, scientific and medical opportunities far beyond the immediate health benefits, over the coming decade and beyond.
The ultimate justification for precision medicine, as for any new health care initiative, will be the extent to which it delivers better health for our community. There is an obligation on Australia to ensure that precision medicine introduces new and measurable improvements to what the world already regards as an excellent, world-leading health care system. I am convinced that precision medicine will be able to provide precisely such outcomes across the system.
Professor Robert Williamson is Chair of the Expert Working Group which produced the ACOLA “The future of precision medicine in Australia” report.