Personalized medicine

In the personalized medicine ( English Personalized medicine ; also individualized medicine or precision medicine ) to each patient with substantial inclusion of individual circumstances will be treated over the functional diagnosis of disease out. This also includes the continuous adjustment of the therapy to the progress of recovery.

If the personalization of a treatment, the diagnostic analysis of the genetic code or proteomic structure based one speaks in this case of molecular-controlled therapy (English molecular-guided therapy ; rare: gengesteuerte therapy).

Use of terms

The term is mainly used for tailor-made pharmacotherapy , which, in addition to the specific clinical picture, takes into account the individual physiological constitution and gender-specific properties of drugs.

In complex therapies, individual molecular biological constellations are also taken into account, which can be determined with modern biomarkers and among which the genetic makeup ( genome ) of the patient or his tumor plays a special role. The influence of the genome on the effect of drugs is the subject of research in pharmacogenomics .

This use of the term “personalized / individualized medicine” in the restricted, biological interpretation is viewed as controversial. The Federal Center for Health Education (BZgA) emphasizes in its key terms that the term "personalized medicine" is misleading in its context of meaning, "as the personal side of the human being, i.e. his ability to reflect and self-determination, is initially not meant, it is raised to fundamental biological structures and processes. ”The medical ethicist Urban Wiesing criticizes:“ Personal characteristics do not manifest themselves on a molecular level, but on a personal level. ” Heiner Raspe from the Center for Population Medicine and Health Services Research (ZBV) at the University of Lübeck rejects the use the term “personalized medicine” in the sense of pharmacogenomically based therapy suggests one-sidedness; In addition to the “biomarkers”, there are also “psychomarkers” and “sociomarkers”, which deserve attention in the choice of medical therapy, as selected examples have shown. The Committee for Education, Research and Technology Assessment (TAB) of the Bundestag proposes the term “stratified medicine”, which is increasingly used in international literature ( stratified medicine ).

In addition to stratified medicine, the term “personalized medicine” can also be used to describe therapies with individual prostheses and implants as well as therapeutic approaches with autologous (body's own) cells (“unique therapeutic items”).

Practical use

Biomarker diagnostics not only include reading out the genetic code , but also all options for characterizing individual features. At the molecular level, these are the diagnostic analyzes of genomic DNA , mRNA and proteins .

“Personalized medicine” is currently therapeutically significant, especially in oncology . One example is the treatment of metastatic melanoma . In a good half of melanoma patients, overactivity of the BRAF protein leads to cell growth (tumors). By introducing an appropriate mutation test, it can be recognized in advance whether the patient is responding to an appropriate therapy. In addition, functional analyzes can identify the activities of enzymes through to responses from cells .

The analysis of the diagnostic data obtained today still represents a considerable challenge in personalized medicine . B. genetic data - obtained from procedures such as next-generation sequencing - computationally expensive data processing steps before the actual analysis of the data can take place. In order to be able to fall back on suitable tools in the future, the interdisciplinary cooperation of experts from different fields is necessary: ​​medical professionals, clinical oncologists, biologists, software engineers.

In its statement "Precision medicine - evaluation under medical-scientific and economic aspects", the German Medical Association uses clinically proven examples to describe the new treatment and healing options that precision medicine already offers today, including in targeted cancer therapy, immuno-oncological therapy, pulmonology and neuropediatrics. The criticism of z. The opinion takes up the sometimes high therapy costs. She states that the financial burdens associated with precision medicine do not, at least currently, call into question the financial viability of the health system. Nevertheless, there is a demand to bring the costs and benefits of precision medicine therapies into harmony.

criticism

The methodical approach in research and in practice focuses on tailoring the patient to the physiological context as precisely as possible. That is the core of a solution. On the other hand, it is completely denied that the organization of inpatient and outpatient treatment and care is already being filled up with formal control requirements without giving the executing persons adequate assistance in consistently implementing and following an optimal process. In particular, in the mostly existing hierarchical control system, there is no systematic communication of the individually tailored treatment plans before they are carried out to the patient's bed. According to current research tenders in Germany, this requirement remains beyond pharmacology without special budgeting.

In a conventionally equipped clinic, it is largely up to the attending physician to control and monitor the implementation of the special therapeutic approach by the specialist nurses involved, without there being adequate information technology support. It is to be expected that the theoretically possible improved results of personalized medicine will not be achieved due to serious organizational deficiencies in the concurrent process control.

Improvements in retrospective medical documentation alone will not solve this increasingly emerging problem when implementing the methods in clinical routine beyond the special measures in clinical studies. The definition of new formal control requirements of the public supervisory authorities does nothing to solve this problem. Rather, there is a need for better mobile availability of information about upcoming activities.

“The development of truly individualized medicine is only just beginning. Substantial research efforts are still required to meet the expectations associated with the concept of individualized medicine. ”This was the summary of a forum organized by the Leibniz Society of Sciences in Berlin together with the Leibniz Research Institute for Molecular Pharmacology in March 2016.

Broadcast reports

• Joachim Budde : With viruses against cancer - Pretty nasty friends , Deutschlandfunk - “ Science in focus ” from June 14, 2015
• Dagmar Röhrlich : Medicine - New Medicines: Hope Bearers and Price Drivers , Deutschlandfunk - "Background" from August 28, 2018

Web links

• European Association for Predictive, Preventive and Personalized Medicine
• Personalized medicine - tomorrow's medicine today (PDF; 1.8 MB) Information brochure, publisher: Zeitbild Verlag und Agentur für Kommunikation GmbH, created in cooperation with the Association of Research-Based Pharmaceutical Companies, September 2011.
• Personalized Medicine - Questions of Justice (PDF; 319 kB) Georg Marckmann, Institute for Ethics, History and Theory of Medicine at the Ludwig Maximilians University in Munich , June 6, 2011.
• Statement by the Leopoldina, Acatech and the Academy Union on Individualized Medicine (longer study, download as PDF possible)

Individual evidence

1. ↑ Peter Leiner: Precision Medicine: Future of Cancer Medicine. In: Doctors newspaper. Springer Medicine, accessed July 30, 2019 . 
2. ↑ CUPISCO study - targeted therapy for CUP syndrome. Retrieved February 1, 2019 . 
3. ↑ Roland Walter, Burkhard Rauhut: Horizons: RWTH Aachen University on the Way into the 21st Century . Springer-Verlag, 2013, ISBN 978-3-642-60242-9 ( google.de [accessed February 1, 2019]).
4. ^ Martin Goetz, Raja Atreya: Molecular imaging in gastroenterology . In: Nature Reviews Gastroenterology & Hepatology . tape 10 , no. December 12 , 2013, ISSN  1759-5053 , p. 704–712 , doi : 10.1038 / nrgastro.2013.125 ( nature.com [accessed February 1, 2019]).
5. ↑ Gooitzen M. van Dam, Samuel Achilefu, Eben L. Rosenthal, Brian W. Pogue: Perspective review of what is needed for molecular-specific fluorescence-guided surgery . In: Journal of Biomedical Optics . tape 23 , no. 10 , 2018, ISSN  1083-3668 , p. 100601 , doi : 10.1117 / 1.JBO.23.10.100601 , PMID 30291698 , PMC 6210787 (free full text) - ( spiedigitallibrary.org [accessed February 1, 2019]).
6. ↑ Isabel Klusman, Effy Vayena : Personalized Medicine: Hope or Empty Promise? vdf Hochschulverlag AG, 2016, ISBN 978-3-7281-3575-9 ( google.de [accessed on February 1, 2019]).
7. ^ Sebastian Schleidgen et al .: What is Personalized Medicine. In: BMC Medical Ethics (2013) 14/55.
8. ^ Theo Dingermann: The value of biomarkers. In: Pharmazeutische Zeitung, edition 20/2012.
9. ↑ Medicine takes it personally - Possibilities and limits of the individualization of diagnosis and therapy ( Memento of the original from July 23, 2012 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. , Bioethics Forum, June 24, 2009 
10. ^ Eva Richter Kuhlmann: Personalized Medicine: Only at the Beginning of the Path, in: Dtsch Ärztebl 2012; 109 (25): A-1305.
11. ↑ Werner Bartens: Personalized Medicine - The Deceptive Pack. In: Süddeutsche Zeitung, July 19, 2011.
12. ^ Alf Trojan, Joseph Kuhn: Predictive medicine and individualized medicine , key concepts in health promotion, Federal Center for Health Education.
13. ↑ Quoted from: Personalized medicine comes from the starting blocks by: Walter Pytlik, Biotech / Life Sciences Portal Baden-Württemberg, February 7, 2011.
14. ↑ Heiner Raspe: Personalized Medicine - End of Solidarity? Annual meeting of the Ethics Council: Personalized medicine - the patient as beneficiary or victim? ( Memento of the original from August 22, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. May 24, 2012. 
15. ^ Stratified Medicine , Personalized Medicine Foundation
16. ↑ ^{a b} Individualized medicine and health system , TAB work report No. 126. Berlin 2008
17. ↑ Simone Ernst: Personalized Medicine: Patients on the Wrong Path ( Memento of the original from January 14, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. , MEDICA.de, July 2, 2012. 
18. ↑ Drugs approved in Germany for personalized medicine , overview on the website of the Association of Research-Based Drug Manufacturers (vfa).
19. ↑ Analyze Genomes: Motivation. Retrieved May 17, 2014 . 
20. ↑ https://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/pdf-Ordner/MuE/20200601_Stellungnahme_Praezisionsmedizin.pdf Federal Medical Association. DOI: 10.3238 / baek_sn_praezision_2020. Accessed July 31, 2020.
21. ↑ Individualized Medicine, Technical Work Area TAB 126 of the German Bundestag for Technology Assessment, Page 21: Summary and Page 49: Visions (PDF; 2.0 MB)
22. ↑ Coordination and quality in health care
23. ↑ Up-to-date maintenance process management needs IT support ( memento of the original from July 14, 2014 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. 
24. ↑ Management of latent hypothyroidism
25. ↑ Peter Oehme and Silke Oßwald: Report on the Leibniz Forum "Possibilities, Limits and Perspectives of Individualized Medicine - Using the Example of Oncology" in March 2016. https://leibnizsozietaet.de/leibniz-forum-moegitäten-grenzen-und- perspectives-of-individualized-medicine-using-the-example-of-oncology-report /

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