From Pajama to Suit, a View of Personalised Medicine

It is said that personal encounters in life shape who you are or what you end up doing. My brush with terminal illness and the desperate need for medical therapy came when my father was struck with colon cancer.

This was a good two decades back. Then there was no mention of personalised medicine in the treatment regime. The best option was surgical removal of the cancer followed by months long frequent visits to the hospital for chemotherapy. As a teenager, I was schooled by the doctors attending to my father that chemotherapy is a blunt tool. You apply it to the body and it affects both the cancer and healthy cells. With enough luck, patients recover. My dad was not so fortunate given that his condition was diagnosed far too late into the cancer progression.

Jump straight into the present, my loss pushed me further down a path of science education and science communication. You can imagine my excitement when I learnt that Professor Aaron Ciechanover, an Israeli biologist and Nobel Prize winner in Chemistry would be presenting a key note on personalised medicine. This keynote was delivered on 17 January 2020 at the Breakthrough theatre in A*Star’s conglomerate of research buildings nestled in One North, Buona Vista. The keynote presentation was part of the Global Young Scientists Summit 2020, and organised by the National Research Foundation Singapore.

Targeted therapies have come a long way from concept to actual delivery. As the work to grow the understanding and science becomes more advanced, more questions will undoubtedly surface. For example, what do we really mean when we say personalised medicine? Does that envision a scenario in the future where our remedies are made for individuals. After all, that’s what the term ‘personal’  connotes right? Professor Aaron dispelled this notion in his lecture by saying: “We are now in the process of being able to profile each of us at a reasonable price in a short time. This means that medicine is changing from being about the disease to being about the disease in the context of the patient. There won’t be a different drug  for every single person, but we should be able to group patients for more customised treatments”. In his words, a way to picture this would be going from pajamas, where it is a one-sized fits all fitting, to a suit where the fitting is tailored.

How are scientists achieving this ‘suits’ approach? It seems that data is joining the battle. Professor Aaron brought up an example in his talk that if we know of fewer instances of cancer among patients who use the drug Metformin for Diabetes, we could target our studies to determine if Metformin can play a role in reducing cancer occurrence. The talk also suggested that it is not all big data or expensive research but knowing ourselves better. A notable example is celebrity Angelina Jolie. Imagine my surprise when a famous face appeared on a scientific slide! Jolie found out that her family had a history of breast and ovarian cancer. These could be attributed to a gene galled BRCA1. Armed with the knowledge that she carried a faulty BRCA1 gene, Jolie decided to have have her ovaries and breasts removed to reduce her risk of developing cancer later on in life.

The talk ended up with a discussion of the cost. Professor Aaron asked at what cost targeted therapies or personalised medicine would come to us? This does not just mean cost in monetary terms, it also means includes the loss of viable lines of research if candidate drugs cause adverse reactions in small groups of patients with unusual genetics. It also means questioning who has access to these treatments and the ethics of engaging with such therapies. There are no easy answers to these questions. We all need to take a measured and collective approach in dialogue to try and sift out the answers. Professor Aaron emphasised that the science and society must move on. If we fail to do so, the cost will be greater when we come up short in potentially life saving treatment options and the chance to know we could have made a difference.

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