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The Aga Khan University Hospital Pakistan

Precision Medicine – A Dream or Reality for Low Resource Countries?

<p>​“Precision Medicine” is defined by The Precision Medicine Initiative as &quot;an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person.&quot; Previously what was known as “personalized medicine”, the term despite being relatively new, the concept has existed in health care for quite some time. A common example is that of blood transfusion, where the blood is typed and cross matched and not just randomly given. Putting it all together, the idea of precision medicine does away with the “one-size-fits-all” approach, where a generalized treatment is given without catering to the individualized needs of the patient.</p><div>While it might be expensive to customize medicine for each individual, using the concept in the initial stages of a disease process will eventually lead to better treatment outcomes and hence cutting down the total cost of treatment. Talking of the future of health care, The Aga Khan Children’s Hospital takes pride to being the very first in Asia, to have started utilizing Etiometry for tracking patient progress and intervening earlier on with regards to the “individualized management” that patient needs. Etiometry Platform is a next-generation patient monitoring software that on the basis of graphic presentation of adequate versus inadequate oxygen utilization consolidates data and helps clinicians better understand the trajectory of their patients by viewing salient clinical information real time on a single screen. It fosters a more precise communication among health care teams and provides a common platform to analyze the best course of treatment for children admitted in our pediatric and cardiac intensive care units.  </div><div>
</div><div>The mushrooming field of precision medicine has also seen some significant developments, with special focus on the use of biomarkers for research. Studies have recently identified biomarkers and genes that could provide possible understanding of the symptoms of Attention Deficit Hyperactivity Disorder (ADHD). A few medical centres in the US, that use the artificial genome to prescribe the most effective drug have already laid the foundation of pharmacogenetics. This therapeutic domain has already led to the birth of  artificial intelligence (AI) of year 2030. Artificial Intelligence (AI) can thus be implemented to not only analyze the data but also provide insights to medical professionals regarding patient’s condition, specially while dealing with them at a molecular level.</div><div>
</div><div>It is not an easy task sitting here in 2018 to estimate the impact of personalized medicine on the future of healthcare. Needless to say, it will improve the cost and time of the biomedical evaluation process and help health care providers take patient based clinical decisions.  </div><div>
</div><div>So does precision medicine have any role in the public health domain? The answer may not be as simple. Where precision medicine takes into account individual health issues, public health is concerned about populations at large. It is these populations with their diverse genetic and socio-economic characteristics that contribute towards large sets of data points. The study of this data through newer technology such as machine learning can help predict high risk individuals. The application of this could include a vast domain of public health issues ranging from investigation of infectious disease outbreaks to prevention of cardiovascular disease. </div><div>
</div><div>The global medical literature has tons of examples where individual data has been used to develop algorithms that can accurately predict occurrence of future disease. One such example is the use of whole gene sequencing for infectious agents which has been used in European countries to study antibiotic resistant patterns of these agents.</div><div>Recently, retinal scan data from 230,000 patients in UK was used to develop an algorithm that can predict cardiovascular disease risk in adults with an accuracy of 70%. This could potentially eliminate the need of detailed scoring which require investigations such as lipid profile along with a trained health care professional to interpret the findings. Retinal scans  can be interpreted by a computer to screen high risk individuals for cardiovascular disease. </div><div>
</div><div>The next important question that arises - is this cutting edge technology feasible in low resource settings such as Pakistan? The answer is YES. The latest UNICEF report has labeled Pakistan as the riskiest country for the birth of a newborn. To improve pregnancy outcomes for our women, it is critical to identify high risk pregnancies in remote settings by frontline health care providers so that appropriate referral can be initiated and newborn lives can be saved. A team of researchers at The Aga Khan University, Pakistan are currently involved in developing a machine learning algorithm to predict adverse pregnancy outcomes (i.e. stillbirth and early neonatal mortality) in peri-urban settlements of Karachi. Once developed, this tool can then be used as a diagnostic modality to “precisely” identify at risk pregnant women at a population level hence improving newborn outcomes. This is where precision medicine and public health would be united to not only improve individual outcomes but also population health indicators.</div><div>
</div><div>This emerging field leads to collaboration between the fields of medicine and engineering. Therefore, potential students from these disciplines need to be sensitized to the art of precision medicine in the early years of their training.</div><div>
</div><div>Having said that, precision medicine is all set to potentially revolutionize the healthcare industry. Richard Tsai of Inspire, a leading social network platform for health, says that “precision medicine will become the bedrock and foundation of science, medicine, and potentially even shape and guide our healthcare administrative architecture”. </div><div>
</div><div><em>This article is written by Dr. Zahra Hoodbhoy, Senior Instructor, Research, </em><em>Peadiatrics and Child Health, The Aga Khan University Hospital and Dr. Sidra Ishaque, </em><em>Pediatric Critical Care Fellow, </em><em>Peadiatrics and Child Health, The Aga Khan​<em> University Hospital​.​</em></em></div>