Personalised health: treating the person

An approach to healthcare that tailors treatments and preventative measures to individual needs, personalised health is a big topic of conversation. So big that Ofori Canacoo speaks to several members of the PHG Foundation about personalised health. What it means to them, examples of where they see it working, changes that should be considered and what they think the future of personalised health could look like.

Welcome back to Making science work for health, the PHG Foundation podcast that explains the most promising developments in science and their implications for healthcare. We discuss the underpinning science, the ambitions for improving population health and the impact it could have on patients, on society and on the people delivering your healthcare.
 
If you would like to find out more about what was discussed in this episode, you can find additional information on our website, https://www.phgfoundation.org/research/personalised-health/.

If you have any questions about the topic then you can email us at intelligence@phgfoundation.org. 

Transcript

Ofori: Welcome to another episode of 'Making science work for health'. I'm Ofori Canacoo, and for this episode I'll be talking to several members of the PHG Foundation about personalised health. This episode was recorded prior to the publication of the UK Government's 10-year plan for the NHS. Our analysis of the 10-year plan's implications is available within our broader observations on personalised health at phgfoundation.org/research/personalised-health.

An approach to healthcare that tailors treatments and preventative measures to individual needs, personalised health is a big topic of conversation I asked Dr. Chantal Babb de Villiers, Jamie Hearing, Dr. Susan Mitchell, and Dr. Pete Mills about what personalised health means to them. 

Chantal: So, health has always been personal. After all, it happens to us in our bodies and in the context of our lives. But now with data and technologies becoming more integrated, we can be much more precise in how we manage our health. For example, instead of offering the same screening protocol to everyone at a certain age, we can start thinking about stratifying risk based on their genetics, lifestyle, and environment, and intervene earlier or more appropriately.

What is exciting is that personalisation can mean different things depending on what your situation is. In some cases, it might be pharmacogenetics where we are tailoring medications based on how someone metabolises their drugs, or it could mean context specific adaptations of mental health interventions.

It's really about understanding the individual within the system and making that system work more intelligently. 

Jamie: So, I think the first thing I'd say is that all health is personalised, both in terms of our individual bodies and our biology and the ways in which we think about and experience our health.

So that's something I'd probably hammer home from the start, is that all health is personalised health and the question that we therefore need to ask is, how do personalised approaches in medicine, in science, in public health, in healthcare help to improve people's health and benefit them? This requires thinking about personalised approaches in a few different ways. So, we could think about how feasible they are or how effective they are. We could also think about how expensive they are or what are the advantages or disadvantages to personalisation, and might there be any unintended consequences. 

Susan: To me, it's about the individual and their unique health circumstances, which might include genomics, personal health history, body, family circumstances, personal preferences, and also the context, you know, the health service or a hospital they might be in.

By thinking about these collectively, you can tailor interventions which actually maximise health outcomes. 

Pete: Ultimately, we only experienced our own state of health. So personalised health is really about the state of wellbeing that enables me or enables you to realise your full capability in whatever material and social circumstances you find yourself.

Now, there are various things that will help with that, and I think these are the elements of personalised health care. First is about respecting the fact that all people are different and that everyone's health can be improved if the differences between us are respected rather than treating everyone as if they were the same.

It's also about treating the whole person, not just their condition or not just one physiological system. And therefore, elements of precision medicine are extremely important, but they're not the whole of the story. It's about putting the person, rather than the services with which they interact at the centre of their healthcare and putting them at the centre of decisions about what healthcare they receive. And it's about recognising people that have a range of interests and preferences of which health is only one, and it may, from time to time not even be the most important of those. 

Ofori: While the realisation of personalised health has faced scrutiny over its claimed potential impact, I wanted to know if the PHG team had any examples of where they see it working.

Here are Dr. Chaitanya Erady, Dr. Hayley Wilson, Heather Turner, Dr. Laura Blackburn, and Dr. Susan Mitchell on their thoughts. 

Chaitanya: Pharmacogenomics I think is a good example because now you sort of take into account a person's genetic makeup before prescribing a drug for them. And this has made a difference in the amount of side effects that a patient experiences, which I think is like a good move forward.

Hayley: Yeah, absolutely. So, one area I find fascinating, which stems from my own interests, is detailed antimicrobial resistance profiling. So instead of just hitting a pathogen with a broad-spectrum antibiotic, we can look in detail using genetic data and we can see what it's truly resistant to. And this can actually shorten treatment duration, and it significantly improves patient outcomes, and it can even reduce costs in the long run.

Heather: So, in the UK genetic medicine service, they have implemented a rapid service to diagnose critically unwell newborns and young children. And this uses whole genome sequencing. In the neonatal and paediatric intensive care units, researchers found that there's a very high likelihood of a genetic cause. And using this test with - in the UK, they found a diagnosis in 40% of patients.

Having this diagnosis allows the clinicians in the NICU and PICU wards to make more informed decisions around treatments or management. And in this time critical setting, this can have a huge impact for these children. 

Laura: So, I think one example of where more personalised health is working is in the development of more targeted screening for people at high risk of disease.

So, for example, a lung cancer screening program has been established, and this program is specifically targeting people who are known to be smokers. And it has been effective in identifying lung cancers at an earlier stage in these high risk groups, and it has been successful to the extent that the people who are running the program have reported that teams from overseas have shown an interest in this now wanting to come and visit and find out what that team is doing and what they're achieving with this lung cancer screening.

Susan: There's been huge progress around breast cancer. You can see that both in terms of the range of treatments that are now available, but also the potential around targeted prevention as we set out in a report a few years ago. I'm also really interested in the growing evidence there is around gut health.

I think it's really intriguing and might help with approaches to prevention across a broad range of health conditions ranging from heart disease to dementia. 

Ofori: I think a general consensus is that there is a way to go before personalised health can be fully integrated into a healthcare system. So, what needs to change?

Jamie Hearing, Dr. Chaitanya Erady and Dr. Chantal Babb de Villiers gave me some ideas. 

Jamie: So generally speaking, the more that medicine and healthcare can look after people as individuals, the better. It makes good sense to me to find ways of personalising care and treatment to the person in front of you where this benefits their health.

Where I'm less convinced of personalisation is in tackling the drivers of illness in the first place, so for prevention. This is because the main drivers of illness are common across populations. These are sometimes called the social determinants of health, and I think our solutions also need to go beyond biology and individuals.

I'm also concerned that the benefits of personalisation are sometimes presented too simplistically, as relying on the use of more sophisticated technologies. It's worth remembering that in all aspects of life, technology can also be depersonalising and can get in the way of being helped or understood.

So, it's important to think beyond technology to understand how personalised approaches can best serve patients. A potentially important aspect of personalised medicine for some people might be the idea of being able to see the same doctor. In general, I think we could do a better job of interrogating the language.

What exactly do we mean and what are we trying to achieve when we talk about personalisation? 

Chaitanya: I think the sort of various sources of data we collect is a good resource to help push personalised health initiatives. Because right now it's still very much in the initial stages and making better use of EHR and other sort of data that we collect from variables would be an interesting way to assess and create new intervention in this space.

Chantal: So, change I would like to see, there's two actually. I'd like to see a greater emphasis on responsible implementation as well as investment in evidence-based integration. So, when I talk about responsible implementation, I mean right now the language around personalisation can be quite broad, even confusing.

Does it mean genetic testing? Is it behavioural nudges? Is it digital tools? I think we need to clearly define what we are talking about, especially for the public and for policy makers. We also need investment in evidence-based integration. There are incredible innovations out there, but they often stay in pilot mode or academic settings.

We need pathways to evaluate, implement, and update tools over time, while considering the cost effectiveness, regulation, health equity, and utility. One last one is, and importantly, I'd like to see personalisation being used to reduce health disparities, not widen them. If we only personalise health for those who are really well resourced, we are missing the point.

Ofori: With all this in mind, I'll be interested to see how personalised health develops over the next few years. Finally, I asked Heather Turner, Dr. Pete Mills, Dr. Hayley Wilson, and Dr. Laura Blackburn, what they thought personalised health will look like in the future. 

Heather: I would argue, and I'm aware that many clinicians will already say that healthcare is personalised. It's informed by the doctor's knowledge and insights of the patient's wishes. But we also know that better decisions can be made by harnessing health data, AI, innovations in health technology, there's a potential to make these decisions much more precise. And for me, the future of medicine will harness these innovations so that we can act earlier and also allow individuals and populations to be healthier for longer.

Pete: I think personalised health in the future is going to require us to become more comfortable with the idea that our lives are going to be subject to more observation, more scrutiny, more surveillance. But I think the important thing about that is that we ourselves are in control of that and understand how that is contributing to our own wellbeing.

Hayley: Oh, I think it's a difficult question, but I think, with the rapid advances in all the various omics technologies, so things like genomics, proteomics, metabolomics, we're gonna see a really wide range of tools become available that will truly personalise care to an unprecedented level. However, I think it's going to be really crucial to strike a balance between what information is available and what information is truly needed and is useful for the patient.

So, this might involve widespread use of wearable technologies, for instance, and that will give us a constant stream of health data. But then on the other side of that, managing that information, figuring out how it can be applied equitably and sensibly is going to be really paramount to its success. 

Laura: So, in the future, I think personalised health could be implemented a number of different ways, and it could look quite different depending on what we decide we want to do and what we want to focus on.

I think one area where it could change is in terms of taking a whole life cycle approach, meaning that we work with people as a health system from an earlier age to keep them healthy and stop them getting sick in the first place. So, this might be more targeted screening at high-risk groups. It might be that you focus on specific diseases or conditions and help people to develop the healthy behaviours that might then mitigate them getting sick in the first place, or slow down disease progression once they're already unwell. But once people are unwell, there's also more specific treatments for diseases. So, for example, in cancer, there are large numbers of targeted treatments depending on the genetics of the cancer. There's also a lot of work being done to implement pharmacogenomics, so testing people's genetics to find out which drugs would be more appropriate for their disease. So, I think it will be a combination of these preventive and far more targeted approaches and treatments for diseases.

Ofori: And that brings us to the end of the episode. I'd like to thank my colleagues for joining me to talk about personalised health. You were listening to Policy Analysts: Dr. Chaitanya Erady, Jamie Hearing, Heather Turner, and Dr. Hayley Wilson; Senior Policy Analyst: Dr. Chantal Babb de Villiers; Head of Science: Dr. Laura Blackburn; Director of External Affairs: Dr. Susan Mitchell; and Director of the PHG Foundation: Dr. Pete Mills.

If you have any thoughts on the subject of personalised health, please email us at intelligence@phgfoundation.org. 

I look forward to bringing you a new topic in the next episode. Thank you for listening and goodbye.