Welcome to the first episode of Medicine made for you, a brand new series from The Anthill, a podcast from The Conversation. Across three episodes we’re taking a deep dive into the future of healthcare – and finding out how it could soon get a lot more personal.
In part 1 of Medicine made for you we look at genes, clinical trials and how possible it might be for the NHS to take a more personalised view of our health. And we find out why Scotland, a country of 5.4 million people, with one of the lowest life expectancies in western Europe, is a pioneer of this kind of research.
Taking a much more precise approach to treatment means that for some diseases, doctors can prescribe drugs based on a person’s DNA. This so-called precision medicine is breaking new ground in the treatment of some diseases. And it could change medicine for good.
We start with a trip to Glasgow to find out why Scotland is leading the way in precision medicine. Anna Dominiczak, regius professor of medicine, vice principal and head of the College of Medical, Veterinary and Life Sciences at the University of Glasgow, talks about the massive potential precision medicine has to help diagnose, treat and prevent disease.
Next we take a tour of a lab to find out what happens behind the scenes. Susie Cooke, head of medical genomics at Glasgow Precision Oncology Laboratory, shows us the sequencing process – allowing us to see first hand how DNA is tested and analysed.
Cooke is trying to improve treatment outcomes, since 90% of the top selling drugs only work for 30-50% of patients. The current so-called “trial and error” method of medicine results in only 25% of cancer patients responding to drugs – as Cooke explains:
Every year 165,000 people in the UK die from cancer and the UK is lagging behind other countries in terms of cancer outcomes … there needs to be a really big shift to improve these statistics. This is all going to be about finding out who does respond to drugs and who doesn’t – and for those people who don’t respond let’s stop giving them those treatments because they don’t work, they have side effects and they cost the NHS a lot of money. And instead let’s find something that does work for those patients that aren’t responding.
Clinical trials are crucial to this process as they can help scientists work out which groups of people respond to treatment and which don’t. Andrew Biankin, regius chair of surgery and director of the Translational Research Centre at the University of Glasgow, explains why he believes patients should be offered a clinical trial at the start of treatment, not at the end. Biankin believes this move would help to remove some of the stigma in clinical trials as it would seem much less like a “last option”.
Lesley Stephen, from Edinburgh, is one such patient who has benefited from clinical trials. She has been living with advanced breast cancer for five years:
My clinical trial has given me a really good quality of life for the last four years. Prior to that I was just on chemotherapy and given months to live. Although with stage four cancer it can’t be cured, the hope is that you can extend your life and live well – but chemo doesn’t give you that. Just by luck, by pure chance, I got onto a clinical trial and have had an amazing response to it.
But she also tells us how hard it can be to find out about clinical trials. There are quite strict rules about who can and can’t go on a trial – the sicker you are, the less likely you are to be accepted. She says many patients don’t even know clinical trials exist. So it seems there is a long way to go before everyone has the choice to join one at the start of cancer treatment.
Despite this, Iain McInnes, professor of experimental medicine and director of the Research Institute at the University of Glasgow, believes that ten years from now, precision medicine will be the new normal. He thinks this way of doing things will simply be part of the infrastructure and integral to the development of new drugs:
The application of an effective precision medicine tool will significantly reduce the cost of care. You’re reducing the likelihood of a non response, you’re reducing the poorer quality of life that is suffered by a person who doesn’t respond to drugs. You’re reducing the likelihood of side effects – which costs money to manage. And most of the long-term predictions indicate that a precision medicine approach could save substantial sums of money for the NHS and the health budgets in many counties beyond.
Not everyone is so optimistic. Stephen MacMahon, principal director of The George Institute for Global Health at the University of Oxford, worries that the current enthusiasm for precision medicine may blind us to the benefits of “imprecise” medicine which saves millions of lives every year. He also has concerns that rolling out a precision medicine approach far and wide could result in some patients taking liberties with their health:
I hear people say that they might not need to change their lifestyle because by the time they’re at risk of heart disease there’ll probably be a cure that will target their genes and they’ll be ok. And I think [in that sense], there are risks about getting the balance and message on this wrong.
It’s clear then that for precision medicine to work more widely it would require a complete shift in the way the health system currently operates. This isn’t to say it’s not possible, but for the NHS to catch up with what the research shows is available, there will need to be a fundamental change in the way medicine is practised.
In our second episode, out on February 25, we’ll delve further into the personalisation of healthcare – looking at the role it could play in our diets and nutrition.
The music in this episode is Is That You or Are You You? by Chris Zabriskie. Medicine made for you is produced and reported by Holly Squire and Gemma Ware, and hosted by Annabel Bligh for The Anthill podcast. A big thanks to City, University of London, for letting us use their studios.