While the model of “personalized medicine” is growing among natural practitioners, there is no consensus of what the practice entails just yet.
• Michael A. Smith, MD, Senior Health Scientist, Life Extension, Fort Lauderdale, FL, www.lifeextension.com
The U.S. Food and Drug Administration (FDA) describes “personalized medicine” as providing “the right patient with the right drug at the right dose at the right time. More broadly, personalized medicine (also known as precision medicine) may be thought of as the tailoring of medical treatment to the individual characteristics, needs, and preferences of a patient during all stages of care, including prevention, diagnosis, treatment, and follow-up.”
But there seems that there isn’t precise consensus of what, exactly, practicing personalized medicine entails, or even if at base, it is a viable model of health care. Opinions differ. This is just a sample.
NP: How would you assess the current state of the theory and practice of personalized medicine?
Dr. Smith: I see “personalized medicine” as evolving. When asked about personalized medicine, practitioners usually give one of two responses: “I already practice it. I take personal medical and lifestyle histories to help diagnosis and identify the best form of treatment,” or “How do I personalize prescription drugs?”
The concept is well received by practitioners, but the application of personalized medicine is not well understood.
Dr. Dean: The term “personalized medicine” just makes me laugh. But it’s an “Oh My” laugh not a belly laugh. It’s completely laughable that medicine has to “legislate” how to be a proper doctor. I learned how to be a proper doctor in medical school in the mid-70s and added naturopathy to my training. A true naturopath and a true doctor instinctively and intuitively follows “The Seven Principles of Naturopathic Medicine,” which are a recognition and belief in the following: The Healing Power of Nature, Identify and Treat the Cause, First Do No Harm, Doctor As Teacher, Treat the Whole Person, Prevention, and The Hierarchy of Therapeutics.
Even worse, personalize medicine is not even about how to make medicine more humane, it’s a deceptive cover name for pharmacogenomics. The FDA’s position gives lip service to “personalized medicine”but in the typical fashion of government, bureaucracy and medicine, it doesn’t mention that the agency is collaborating with patients. They are always left out of the equation while the “powers that be” pat themselves on the back that they are “doing the right thing.”
If only “personalized medicine” were about taking into account the patient. But it’s just about genetics. Evidence of the erosion of medicine is the failure of primary care doctors to care or give primary care or even be available to their patients. Primary care doctors have four-to-seven-minute appointments, hardly ever examine their patients, mostly make referrals and write prescriptions. The patient is shunted off to a specialist who attends to his/her specialty using drugs and surgery and no one is in charge of the whole person and nothing in the way of alternative choices for medical treatments is ever discussed.
NP: What challenges exist in typical modern patient-care to provide more personalized medicine protocols for individuals?
Dr. Smith: For one, relying on “protocols” less. A structured approach to a given disease or symptom based on evidence is helpful, but should not be the primary method of practicing medicine. Time is another challenge. To personalize medicine, clinicians need more time with each patient—more time for in-depth medical inventories, more time for historical, molecular and genetic analysis, more time for ranking and scoring symptoms, and more time reviewing genetic and laboratory tests.
Dr. Dean: To be “personal” with patients the practitioner needs to talk to them, find out who they are, what they eat, what their health goals are, what their stressors are. You will never find all that out in four to seven minutes. So, in my experience, true personalized medicine will never happen. The only challenges are to the agencies that want to test everyone’s genes. I suppose their challenge is to make sure insurance, that we are all forced to pay, will cover the costs.
NP: How can personalized medicine be practiced for potential prevention? Any chance of this becoming the norm for true “health” care rather than “sick” care?
Dr. Smith: Using single nucleotide polymorphisms (SNP)—genetic variations of a gene—testing is the hope of preventative medicine. By studying the genomes of patients with known diseases, we can identify SNP that are common to the disease. Healthy people can then test their own genomes, looking for those same SNPs. If they are identified, it’s an increased genetic risk of disease. With this kind of information, patients and doctors can initiate preventative lifestyle strategies.
NP: What key research about genetics, technology or related personalized medicine do you find appealing, compelling and/or potentially even groundbreaking?
Dr. Dean: It’s a myth that we can affect our genes. Instead it is the epigenetic factors of environment, vitamins and minerals that turn genes on and off. Gene testing is inappropriate, ineffectual and scares patients. It’s an attempt to recoup some of the billions spent on the Genome Project. And I guess medicine knows that, so it’s turning genetic testing into individualized drug testing to see what drugs will work on which individual. But even that won’t work because they will continue to ignore vitamin and mineral cofactors that rule every metabolic process in the body.
My major expertise is in magnesium—magnesium is required for 700-800 enzymatic processes in the body. Magnesium turns genes on and off. Many drug side effects are related to magnesium deficiency because drugs deplete magnesium. All that needs to be done to personalize medicine is to do accurate ionized magnesium testing on all patients, replace magnesium losses with highly absorbed magnesium and watch their health improve. Instead medicine has bought into the pharmaceutical industry’s monopoly on health and disease and is entirely focused on drugs, vaccines and surgery.