Prasun Mishra, PhD, founding President and CEO of the American Association for Precision Medicine (AAPM), says the demise of his elder sister to pancreatic cancer led him to this work to create awareness about precision (personalized or individualized) medicine.
“It was a kind of a calling for me,” Mishra told Indica at the AAPM Annual Meeting 2019 held this past month at the Santa Clara Convention Center. “Initially I was very sad for my personal loss but eventually I realized it was not just me. Everyone is fighting the same battle and has similar story and I am just one of them.”
The daylong meeting was based on the theme “Accelerating Precision Medicine and Transforming Patient Health.” It was attended by both national and international scientists, professors, experts, and thought leaders in the fields of precision medicine, life science, biotech, MedTech and pharma.
Dr. Mishra, a serial entrepreneur, is the Founder and CEO of Agility Pharmaceuticals. He founded AAPM in 2017 with a mission to save lives by accelerating the field of precision medicine through research, education, communication, and collaboration.
Dr. Mishra says that it has been an exciting journey to build a precision medicine community to fill the void between the 4Ps of precision medicine, patients, payers, providers and public health planners (i.e. the government). Creating the prescision medicine community required grassroot level efforts as well as meaningful dialogues with the leaders in the field to bring the stakeholders together.
“In our community we have medical doctors, pharma executives, investors, entrepreneurs, and scientists who are putting their heads together to solve some of the toughest problems,” he added.
A lot of work has been done in the field of precision medicine at the universities, hospitals and at pharma companies in the previous decade. At present, precision medicine is getting integrated in healthcare but it is still in the burgeoning stage.
When asked if lifestyle is a part of precision medicine, Dr. Mishra said, “Lifestyle plays a big role in defining our health. Today we are monitoring patient’s health and behavior [to see] how it impacts their life […] and trying to see how we could, through technology and resources, predict based on their lifestyle what outcome the patient would have.
When asked about former President Barack Obama’s launch of the Precision Medicine Initiative in 2015 and the $215 million investment in the President’s 2016 Budget Dr. Mishra said that the Precision Medicine Initiative as well as other US government’s research programs, including the ‘All of US’ program, have propelled the field significantly forward. He also mentioned that even private companies like Verily, a Google company, is working on similar project, called Project Baseline, where they are profiling individual’s lifestyle, including sleep patterns and genomics data. Google also recently acquired Fitbit for $2.1 billion.
So what has been the main driver for the increased awareness of the field of precision medicine? Technology, or deadly diseases, such as cancer? Dr. Mishra believes that it’s a combination of both, fueled by the frustration of not being able to accelerate the field of precision medicine to actually make a difference in the lives of our loved ones.
During the panel discussion, Dr. Mishra also highlighted another move by Google that might help boost this growing demand, said, “I think Quantum computers will be very good [at performing] certain tasks in the future and Quantum computers is much needed as it works much faster than regular computers.”
But there are challenges, when it comes to data, Dr. Mishra stated that there are a lot of data in healthcare system available in paper based medical records which is a big problem.
“Now we are trying to work together as a community, and as a consortium, on solving this issue. The manual data needs to be digitized or you can say the whole health care system needs a big overhaul. There are many hurdles to overcome, and we have to move forward and solve each one at a time.”
“We have a lot of unstructured data that is being generated. To train our AI we need defined and curate our datasets. Hence, a solution would be to intensify our collective efforts to collect more of the structured data,” Dr. Mishra said.
When asked if there is awareness of personalized medicine among the South Asian community, he said that precision medicine’s goal is to stratify individuals into subpopulations i.e. the communities. Our ‘exposome’ (e.g. our diet and lifestyle) can help determine what diseases we are prone to, and based on our genomic makeup, we can also predict of what drugs we will respond to. It would be great to have a community specific genomics dataset, some companies/organizations are working on it… but still we are far behind in terms of collecting massive ethnic datasets. We could come together as a community to expedite this effort.”
Adding further he said that as a community [coming] together would generate a pool of data that would help understand what kind of diseases we are prone to and what medicine the community would respond.
We are also identifying some of the common genetic variations that are missing and/or gained within a community and use that knowledge to deliver the promise of precision medicine,” said Dr. Mishra and added that the next 10 years, are going to be truly very exciting.
“Technology is progressing exponentially, especially with AI interventions in healthcare; AI could read radiology reports, detect diabetic retinopathy, and many forms of cancers at par with physicians,” Dr. Mishra said that AI interventions would not only accelerate precision medicine but also can help rural areas where there are no physicians.
“The future is very bright and as a community, if we are passionate about making a difference, we will make the progress in implementing precision medicine in the routine clinical practice in the next decade or even much earlier.”
Another speaker at the conference, Pritmohinder Gill, PhD, Associate Professor at the Arkansas Children’s Research Institute, UAMS, said the demand for Precision Medicine grew because of an interest in cancer research.
“Cancer is the medical field in which most therapeutic value from precision medicine lies. In this area it gains the most benefits because we are able to target particular cancer genes in a particular individual,” said Professor Gill.
But he sees that it will take a long time to expand precision medicine to its potential as it’s currently expensive in the areas of research, medicine, and technology.
He said a single genetic test could cost $3000 per patient. Some companies can do the same test for $1500 dollars.
“UAMS has a limited amount of funding for precision medicine, and without the growth of technology and Artificial Intelligence, it’s very hard to compete with drug companies.”
“Without research, there is no understanding of the relationship between a person’s genetic makeup, the drug, and the dose. The key is research and only after research, can you take these findings to the patient i.e., bedside.”
Pointing to the recent drugs approved by the FDA, he said that in 2018, 42 percent of drugs approved by the FDA were personalized medicine drugs.
When asked how to reduce the cost, Professor Gill said that in Norway they have a population of 6 million and all the inhabitants in Norway have their whole genome sequencing done. The UK has current plans, and they will make whole genome sequencing results available in the patient database for physicians to access while they are prescribing medication.
That’s basically where healthcare will move in USA.
Prof. Gill believes it could take 50 years because it’s all about funding and the need for regulations, and that will depend on the FDA.
Meanwhile, Dr. Sanjeev Jain, CEO of The Columbia Asthma & Allergy Clinic who spoke at the panel, “Role of Physicians Transforming Precision Health” says precision is useful in helping to customize the treatment plan for each individual when doing allergy immune therapy.
He said he had lots of data but not enough resources, so he is looking forward to collaborating with Stanford University to build a joint database.
“Currently the database is going to be focused on food allergies. Hopefully in future we can do it for other diseases,” said Dr. Jain.