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Precision medicine – A prudent avenue for tailored patient care

The Covid-19 pandemic has catalysed the need to explore novel, innovative and more targeted ways of preventing and treating infectious diseases. Approaches like precision medicine (PM) have emerged as a new paradigm in disease management that utilizes molecular data as a basis of clinical diagnosis. Recent advances in molecular biology, bioinformatics and omics and their application in treatment of health disorders has brought PM based approaches at the forefront. The term precision medicine was advocated by a wide range of experts and entrepreneurs in the US in the year 2015. This formed the basis of the reorganization of interests and political will in academia, industry and governments in favour of PM.

PM readiness and care integration
The integration of PM into care delivery can be termed as care integration, which can further be defined as the people, systems and supports required to deliver this more targeted approach to healthcare. The interplay of research, data and engagement would be essential for care integration.

Globally, the application and integration of PM into clinical care is nascent, and majority of published research on PM implementation is from the US and the UK. However, of late LMICs have started to galvanize research pertaining to global efforts on PM integration into routine care by way of summits and conferences.

The World Economic Forum Platform for Shaping the Future of Health and Healthcare launched the Precision Medicine Readiness Principles in 2021 and described the infrastructure and societal needs for care integration. Countries can draw upon from these principles to evaluate their readiness for widespread adoption of PM into healthcare.

PM in India and way forward
The core of PM and predictive health relies significantly on data. The more is known about genetic variation, gene–gene interaction, epigenomics, and other variables, the more precise and predictive it would become. However making sense of this data requires collaboration between a wide group of professionals like clinicians, bioinformatics experts, biostatisticians and programmers etc. Therefore accessible and readable data made available to the clinician and public health expert combined with unique digital solutions that can be integrated on to intelligent platforms is important for delivering clinical care and improved patient outcomes. Deep learning technologies and AI can be leveraged to deliver sophisticated diagnostics and medical imaging reconstruction techniques.

India is currently in the nascent stages of adopting PM approaches; however it is positioned on the right path. The Ayushman Bharat Digital Mission launched in 2019 aimed at establishing state‑of‑the‑art digital health system and promote the use of clinical decision support systems by the health professionals and practitioners has access to health data of individuals subsumed in health ID and it can be instrumental in giving a fillip to PM adoption. The progress of ABDM provides for an opportunity to build data repositories that help in understanding profiles for arriving at differential diagnosis. Other important landmark steps have been the Indian genome Variation Database started in 2003, launch of Genome India Project in 2020, Indian Cancer Genome Atlas started in 2021, launch of Unique Methods of Management and Treatment of Inherited Disorders (UMMID) in 2019 for the prevention and management of inherited genetic disorders, Indian proteomic database etc.

Another important aspect here is the requirement of invoking a new paradigm in medical education in order to have manpower that understands and utilizes an integrative approach in patient care that aligns with a PM approach. Medical graduates with knowledge of omics and its application would tremendously benefit clinical decision making for improved patient care.

The holistic picture in PM can be visualized when clinical outcomes are linked to choices in biomarker testing, screening and diagnostic methodologies and specific treatment regimens for large patient groups as part of translational research and clinical trials. Strengthening molecular biology laboratories is crucial for pursuing new biotechnologies and personalized therapies. Therefore investments in research infrastructure would be instrumental for promoting PM for future readiness and response to epidemics and other diseases.

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