Personalized Medicine: How to Manage It Through Autonomy?

If they exist Two keys to health To assure a Personalized medicine A success throughout Spain, that is Precision prevention (early disease detection) and molecular diagnosis. But incorporating these technologies is not an easy task and the variations among autonomous communities lead to different voices in the field to warrant their promotion throughout the region to move towards quality precision medicine. In a discussion organized by Medical writing It has been analyzed in collaboration with Roche Pharma Spain What is the plan to promote personalized medicine? Running in communities and if it is adequate, the combination of detection and diagnosis in the approach of different nodes or the use of artificial intelligence tools applied to it.

for Carmen DuranThe success of the implementation of these plans at regional level depends on the General Director of Public Health of the Ministry of Health of the Government of Galicia. There is a “significant budget” and a common repository of health data To collect all information by communities: “If we want to go a step further, let’s do it with a budget. To achieve effective development, it is also necessary that we have a common repository of health data, exchange of information or Standard operating procedures in all communities“, explain.

Federico Rojo, director of molecular pathology at the Jiménez Díaz Foundation Hospital, points out that these plans are “already too late.” “We know that in some regions There are 30 or 40 percent of patients who do not have access to molecular diagnostics Or for precision medicine because in that community they don’t have the resources to be able to do that, and this is serious,” he points out, adding the need to articulate a common strategy to achieve that.

Steps forward in personalized medicine

Advances in the field of personalized medicine have been remarkable. Achieving greater progress in early diagnosis using not only environmental risk factors, but also individual polygenic risk factors may help. Luis Paz-AresHead of the oncology service at the Hospital 12 d’Octobre, for better predictions “whose patients should be vulnerable to risk.”

“In a way it is Universalizing this precision prevention or early diagnosis to a certain extent. I think it is a reality and we have more and more knowledge and better technology. It may not be available tomorrow or for all patients, but I think in the next ten years we will see great progress in this regard. To do this we have to demonstrate convincingly that these studies do what they are supposed to do, detect and prevent early, and be able to implement population plans that truly integrate what the experimental studies have told us. Today we have Examples where early diagnosis is effective and we still don’t do it, Like lung cancer. We have very solid data for more than ten years and we still don’t have a clear implementation plan in the country as Europe requests and especially the countries around us,” he admits.

New professional profiles in personalized medicine

Experts have also discussed the growing need for “decisive commitment” in all autonomous communities. Development of personalized medicine should be undertaken Generation of new professional profiles That they be included in the health system, because there are currently profiles that are “not even included as such at this moment” in the health system.

Beatriz Bellosillo, Head of the Molecular Biology Division of the Pathological Anatomy Service at Hospital del Mar, It highlighted the importance of trained personnel to understand the data generated, interpret it properly and communicate it to the end client, which for us is the clinician, who will make a decision for the patient. “Those are the other objectives that I believe are now being worked on from different points of view, we should organize these profiles within the health sector. Generally the interpretation of most of the data. Requires profiles not yet provided“He analyzes it.

Federico Rojo highlights that, today, the possibility of including these specific profiles (molecular biologists and statisticians) in the public health system is not always considered in all communities. “It’s not always possible and a lot of people that we train or train in this kind of technology, who don’t have a regular kind of contract in the system, they often resort to research projects, research foundations and I think formulas. That too. It is an obstacle that we have to overcome to achieve full implementation“, add.

AI tools

Implementation of tools Artificial intelligence for the development of personalized medicine Some communities continue to grow. In the Galician case, Carmen Duran has analyzed the use of this AI for breast screening. “What we do is the mammograms are read in pairs by radiologists and at the moment we’ve added the third leg which will be the AI ​​tool. We start with 35,000 tests and then we’ll assess whether it’s worth continuing. But we believe Being that is an important element to be able to Incorporate AI into breast cancer screening“says Duran. Something they’ve incorporated with colon cancer screening, through a tool in all hospitals.

In addition, Duran showcases two more AI projects, one of which is in lung cancer screening, based on a lung cancer risk stratification algorithm. On the other hand, another project at the European level focused on prostate cancer screening stands out: “This algorithm also stratifies the risk and aims that the biopsies performed are as minimal as possible and for this there are various intermediate steps. When we personalized medicine talking about, This medicine for public health is going hand in hand with AI Because we need a huge database where we have to extrapolate the results,” he says.

The role of the pharmaceutical industry in personalized medicine

This debate has left room for discovery, among many other aspects of precision medicine. What role does the pharmaceutical industry play? In it Teresa RamosThe head of personalized medicine at Roche Pharma, points out that his “initial mission” will be the development of new innovative treatments for cancer patients but assures that he has seen for years that it is “inadequate”: “There is. Other unmet medical needs And for some time we have been working on developing health technologies that accompany this arsenal of new treatments. And, above all, we are working in two areas in terms of health technology. First, in digital health, which is any information or communication technology that helps us Promote better health Or health care for patients,” he admits.

Another pillar, in addition to digital health, which Ramos highlighted, is related to the genomic diagnosis of tumors to determine the most effective treatment for each patient, Support professionals and the scientific community in building evidence To measure needs and outcomes: “What will it mean for me to incorporate this new technology into clinical practice and what impact will it have on health outcomes? Generating this evidence will help us accelerate the incorporation of these technologies into clinical practice. To the pharmaceutical industry we will provide tools, technologies and With evidence, we try to back it up with clinical trials that help us understand how to use these technologies,” he concludes.

Health authorities and precision diagnosis

European countries have made plans for precision medicine and Access to molecular diagnostics “For many years” and for Federico Rojo, the model “we all have in mind” is France, as it has a network of centers that guarantee molecular diagnosis with high-performance techniques to all patients. A situation that is not like Spain, but recognizes that something is changing. “In June we first had a Publication of a portfolio of services in genetics and genomics Which includes something that was never written, which is the diagnosis of somatic changes, in the concept of precision medicine. Drug prescription. This is the result of three years of work with a group of experts who have advised the ministry and with representatives of all autonomous communities,” he admits.

Rojo assures that it has been used to promote and include him Biomarkers that are essential for cancer patient diagnosis and treatment in 2023. “For the first time this publication includes a list of tests that any cancer patient in the national health system must have access to and now it is the responsibility of the autonomous communities to develop implementation plans and guarantee access to these tests. Let us not forget that in a decentralized system like ours, the Ministry In addition to publication by, it is each region that has to specify how to develop and cover that portfolio of services in each community,” he recalls. Although not all are equal, Rojo insists that this is a first step, the A “stepping stone on the path” to precision medicine policy and strategy..