The times are changing and advances are being made in precision medicine every day. But how will that affect our GP visits? TechWatch’s Emily McDaid reports.
Last week, esteemed researchers and professionals in precision medicine attended our Fourth Industrial Revolution Challenge (4IRC) debate at the Ormeau Baths, Belfast. The presentations asked the question: ‘What will a visit to the doctor look like in 2030?’
Several changes were predicted, such as:
- No waiting times to find out what’s wrong – instant diagnostic results
- No more invasive tissue biopsies – liquid biopsies will be mainstream
- Stratified medicine will be the norm, where cancers will be categorised and treated more specifically
- Doctors will keep your tests on file for future diagnoses
The first speaker was Prof Richard Kennedy, whose specific work is profiled here. He explained: “There are 9m kilometres of DNA in a human body being damaged all the time. Enough mutations will equate to cancer. This was our old way of looking at things.”
But Kennedy showed that now, we understand there’s a lot more going on. “In truth, there are many more routes to cancer.”
He explained the differences between stratified medicine (which treats subsets of patients – for instance, breast cancer patients that are HER2-positive), precision medicine (which treats the exact disease you have) and personalised medicine (which treats the actual disease specific to your own body).
“There’s clearly a need for more precise biomarkers but there are many challenges to this.”
He then discussed how a medical ‘tricorder’ device similar to Star Trek’s could be a reality by 2030. “People want better diagnoses, and analysis at the bedside is the way things are moving,” said Kennedy.
Next up was Queen’s University Belfast School of Pharmacy’s Dr Niamh Buckley, whose work is profiled here. She talked about the importance of opening up data sources for the whole academic community. “We need to move to holistic approaches to science and cancer.”
However, the battle against cancer is uphill, she explained. “Within a patient, the cancer is a village. There are lots of clones and lots of cell types going on. Sometimes, the cell shouting the loudest isn’t the most important. You might have one cancer at the beginning of treatment turning into another cancer at the end.”
Buckley explained a bit more about the theory of liquid biopsy: “We’ll have the ability to detect different biomarkers in body fluid. Cell free DNA or exosomes could contain information from cancer cells through the body.”
Finally, she discussed the challenges to identifying more specific biomarkers:
- Collection of data, and the preprocessing of data, avoiding garbage in and garbage out
- Ethical considerations and anonymity
- Cost – “But costs are always coming down – for example, the human genome project cost $3bn, and now we can do that for $1,000.”
The final speaker, Dr Hugh Cormican, is a doctor of physics and CEO of Cirdan. Based in Lisburn, Cirdan supplies half a million tests/requests a day to laboratory information systems.
Cormican said: “The old way for cancer treatment was patient biopsy > lab >pathology. The new way involves varying treatment for subsets of patients.
“Now, the pathway goes: patient blood sample or biopsy > proteomics (mass spectrometry) or genomics (DNA, gene chip) > microarray images.”
He discussed the main challenges to progress: “How do we communicate results to patients? The extraction of data and who owns the data? Ensuring there isn’t overregulation of industry that would stifle innovation? These are the challenges,” said Cormican.
“In my view, regular visits to the doctor in 2030 will not be prompted by illness. Your doctor will have a wider range of tests; both you and your doctor will have a more holistic view of your health. This will include your state of mind as well as physical conditions, and the focus will be on prevention, not on cures.”
Finally, the panellists took questions from the audience.
Precision medicine is for smaller cohorts of patients. Does that not create problems for the NHS?
Kennedy answered: “That’s why we want to move to the one-test model. The same test will be given to everyone, used to test for many different things.”
How do you decide which cell types to target first?
Buckley said: “That’s the million-dollar question. Do you try to stop resistance happening or do you wait ’til resistance happens and then treat effectively? You can debate either way. Cancer is the best example of evolution – it always adapts accordingly.”
Why do we need GPs?
Cormican answered: “I think you need a life coach, to take a more holistic and preventative view. You need someone to be your guide through a very specialised process.”
If you had £10m to invest, what problem would you solve?
Kennedy said: “I’d solve the heterogeneity problem; that is, if you measure a tumour from one site, it might not show the same as other sites. You hope that first test shows everything but, in reality, it doesn’t. The future of that is imaging. A new area called functional imaging uses probes to determine different tumours.”
What will be the next innovation in precision medicine?
Kennedy said: “The one-stop test: the patient is biopsied and that sample can be used for years. I believe that will become a reality in the next three to four years.”
The next 4IRC debate, Blockchain: Should we question the hype? will be held on Tuesday 7 November at 5:30pm at the Crescent Arts Centre.
By Emily McDaid, editor, TechWatch
A version of this article originally appeared on TechWatch