Release date: 2015-04-10
If the "Affordable Care Act" is one of the biggest achievements of President Obama's term, his "precise medical plan" proposed this year is a icing on the cake. From the very popular "Transformation Medicine" in 2014, because of Obama's speech at the beginning of 2015, because Obama did not mention "transformation medicine" in the whole plan, the limelight in the life science field was overshadowed by "precise medical care."
How accurate is precision medicine? How do government, science, business, and media circles view the lofty dream of "precise medical care"? The Bio-Exploration Editor compiles opinions from representatives from all walks of life and takes you through a comprehensive understanding of the attitudes of all parties involved in “precise medical care†to reduce the risk of being fooled.
Following the Obama administration’s speech on January 20, 2015, as the State of the Union address, Wang Yongjun, vice president of Beijing Tiantan Hospital, put a shock bomb at an academic conference, detonating the circle of public opinion: the Ministry of Science and Technology decided in 2030 Before, a total of 60 billion yuan was invested in the development of precision medicine. However, the bio-exploration editor has not found any red-headed documents on the implementation of “precise medical treatment†in China through the search of official websites such as the Health Planning Commission and CFDA. Therefore, whether the country keeps pace with the United States and develops a “precise medical†plan that suits China’s special national conditions is still under discussion.
NIH self-interpretation of the "precise medical" program
Francis Collins, the current director of the National Institutes of Health (NIH), published an article detailing the precision medical plan in the New England Journal (NEJM) on the day of Obama's accurate medical plan on January 30. The article talks about short-term plans and long-term plans for precision medicine. The following is a graphic compilation of the interpretation.
Science: Yang Huanming summarizes "precise medical care" in six sentences
Chairman of Huada Gene and Dean of Huada Gene College, Yang Huanming made a preliminary comment on Obama’s precision medicine based on the original text of Obama’s message and Obama’s own speech on January 30 and his think tank’s narrative of precision medicine. Precise interpretation.
A striking arrangement - a color DNA double helix model
When the long-awaited people in the annual State of the Union’s State of the Union address entered the venue, everyone’s eyes were attracted by a delicate color DNA double helix model placed on the left side of the podium. Surprise and surprise: this is the United States. Is the president’s briefing on the world and the state of the country a academic speech by a natural scientist?
It can be said that this is a well-thought-out and well-planned strategy of Obama's think tank. It is intended to tell Congress and the Americans that the scientific foundation of ObamaPreciMed is the DNA that everyone agrees with, not any other "gimmick" of whim.
Two important contributions - the eradication of polio and the Human Genome Project
In addition to placing the DNA model, Obama's think tank can be described as word-by-word, with a slogan that allows Obama to briefly and accurately present his own version of precision medicine in a limited time.
The United States, a technology superpower, has contributed to life sciences and medical clinics for more than a century, but Obama’s think tank has given him only two contributions: the eradication of polio and the Human Genome Project. Initial completion.
In his January 30 speech, Obama cited a data from a study: the return per dollar spent on the Human Genome Project was $140. "This innovation has received huge economic returns, and there is absolutely nothing wrong with applauding this innovation." He also specifically mentioned that the cost of analyzing a human individual genome is now as low as $2,000, so "the time to start precise medicine is ripe, just like the decision we made on the Human Genome Project 25 years ago."
Another important figure in the American scientific community, Philip Sharp, chairman of the American Association for the Advancement of Science (AAAS), which has a global influence to host Science magazine, once called the discovery of DNA double helix and the human genome project the first in life sciences. One and the second revolution. And David Baltimore of CalTech recently made an interpretation of precision medicine: "The vision of precision medicine is driven primarily by two important technologies - DNA sequencing and genomics."
In this sense, it is responsible to say that the Human Genome Project is the scientific basis and guiding ideology that Obama's think tank has prepared for ObamaPreciMed.
Three representative diseases - vesicular fibrosis, diabetes, cancer
The United States and the world have to deal with thousands of diseases, but Obama has only cited three examples, with the highest incidence of vesicle fibrosis (CF, Cystic Fibrosis) in Europe as a monogenic disease or other rare diseases. For example, diabetes is an example of a common complex disease, and cancer is listed as "the most important thing". "(Precise medicine) brings us closer to curing cancer."
Obama’s think tank arranged for him to attend a speech at a 27-year-old CF patient, Bill Elder, as a guest of his wife, Michelle. Obama’s speech on the 30th added: Bill was diagnosed as CF 20 years ago. A few years ago, the FDA approved a new drug in a "special channel" that targeted specific mutations in about 4% of CF patients. Bill began to use in 2012 and immediately became effective. "This is not only a miracle of his personal life, it is not just a case, but an encouragement to all others." "This is the Spirit of Hope." "This is not the fate that we decided at birth, we can redefine our lives."
Obama also cited an example of leukemia: "A new target drug for a particular gene is used, and blood cells in 80% of patients return to normal." "We have 'typed' our genetic code with cancer and become a viable standard. We decide that the dose of the drug will be as convenient as measuring our body temperature - this is the hope that precision medicine brings us." “Precise medicine gives us the best opportunity to achieve new medical breakthroughsâ€.
Four basic elements - precise, punctual, shared, individualized
In Obama’s message, four elements (precise, punctual, shared, individualized) are listed for his plan:
First, the right treatment
Beginning in 2010, Obama’s scientific think tank, also a friend of the scientific community, began to design a new blueprint for American medical development.
In his speech on January 30, Obama added this statement to "appropriate patients, appropriate time, appropriate treatment." For “appropriate treatment,†Obama cited the example of AIDS patients: “The genetic testing of them allows doctors to know who these new anti-diseases will work for, and who will have bad side effects. The patients who are benefiting are not enough now, but they will become more and more, and the future will be in sight."
Second, at the right time
Franch Collins, director of the US NIH, one of the important figures in the Obama think tank, said in a subsequent report that "Timingis Everything". All medical treatments are only appropriate at the right time, which also reflects the meaning of predictive medicine and preventive medicine, namely “five beforeâ€: suitable time periods before, before, during, before, and before the symptoms. .
As Obama said, “I want to ensure that the system we build can prevent disease and ensure health, not just relying on post-onset treatment.â€
Third, share (give all of us access)
The key to ObamaPreciMed is that the development of medicine should make "keep ourselves and our families healthier."
Sharing also means “to be sharedâ€. What makes Obama proud is that "so many patients support it with all their strength. Today they are with us. They don't stand by and don't want to just post the guns. They helped design the project from the beginning."
Indeed, Kaiser Permanente, a private pharmaceutical company, the Mayo Clinic, and the government-related agencies of the Department of Veterans Affairs, have expressed support for precision medicine. And participation.
Fourth, personalized (personalized information)
Obama has not degraded or rejected the idea of ​​another modern medicine, "individualized medicine" - "some occasions, some people refer to precision medicine as individualized medicine." “Every patient is unique. Doctors are always doing everything they can to get medicine. Just like you have to transfuse blood, blood types must match. This is a very important finding.â€
Five specific content
Ten days later, starting at 11:19 am on January 30, Obama announced the specific content of the Obama version of the Precision Medicine Program in the East Hall of the White House. This is the most comprehensive and accurate "Precision" for the Obama version of precision medicine. Self-interpretation.
First, launch the "Million Human Genome Project" (funding NIH $138 million). First, we must collect 1 million volunteers and do a cohort and control. Establish “unprecedented big data†related to the clinic and collect genomic data and clinical information.
Second, to find the genetic factors that cause cancer (funding NCI 780,000 US dollars), that is, continue the United States has begun the cancer genome research program, namely the TCGA (The Cancer Genome Altas) program.
Third, establish a new method for assessing genetic testing (funding FDA $10 million), especially for the evaluation and approval of new generation sequencing technologies, and the protection of intellectual property rights and related copyright management to ensure the demand for precision medicine and related innovation.
4. Develop a series of relevant standards and policies (funding ONC 5 million US dollars). From the first day, efforts must be made to protect personal privacy and the security of various data.
5. PPP (Public-Private-Partnership, public-private partnership). “I invite entrepreneurs and non-profit organizations to help us.â€
As some people have said, the five specific contents of ObamaPreciMed can be divided into three parts: one is scientific content (millions of Americans sequencing and cancer genome); the other is the corresponding change of government functions and the establishment of regulatory standards; the third is public-private cooperation. , social participation.
Six reading aids
First, the position of ObamaPreciMed in the State of the Union address is placed in the US government's "21st Century Economic Layout", listed before the Internet, infrastructure and expanded exports, which deserves special attention. ObamaPreciMed has indeed won the support of the Democratic and Republican parties, which is very rare. He also quoted the newly elected Republican Congressman Bill Cassidy: Precision Medicine is "a field of hopelessness."
Second, the speeches and articles published by Obama's think tank helped to accurately interpret ObamaPreciMed, and further explained that this was his brainstorming team's long-planned and well-planned.
NIH's current director, Francis Collins, and former director Harold Varmus, an article entitled "New Plan for Precision Medicine," was published almost simultaneously with Obama's speech (January 30, 2015). Eric Lander, one of the presidents of Obama's Science and Technology Advisory Board, published in the same journal (ENJM) (March 13, 2015) "Developing and Regulating Genome Testing in the Age of Precision Medicine (Cutting the Gordian Helix - Regulating Genomic Testing in the Era of Precision Medicine), further emphasis on government regulation issues. NIH Director Francis Collins also made a further interpretation of ObamaPreciMed in a speech on February 11.
Third, "21st Century Medicine" has a variety of different formulations, known as 4P + TIDEST (Prediction, Prevention, Participation, Personalization and Targeted, Integrated, Data-based, Evidence-based, Systems Medicine, and Translational Medicine ), all trying to reflect the new features and lead the new direction, but there are ills or misleading. It can be said that ObamaPreciMed is inclusive of 4P, Targeted and Data-based Medicine, and does not conflict with the slightly new ideas of Integrated, Evidence-based and Systems Medicine. Obama changed to "Precision" this time, and he must have his own deeper considerations. However, perhaps even more noteworthy is that in his own statements with all think tank members, there is no mention of the popular “transformation medicineâ€.
Fourth, the application of precision medicine to more important documents, perhaps the earliest report on November 1, 2011 in the name of The Institutes of Medicine, "Toward Precision Medicine" report, For the first time, a comprehensive and detailed description of precision medicine was made. The main point was the “symptomatic medication†based on the “classification†of diseases, creating a biomedical knowledge network and a new classification of diseases (Building a knowledge). Network for biomedical research and a new taxonomy of disease). Among them, the content related to precision medicine was drafted by Maynard Olson, the important person in charge of the Human Genome Project.
5. So far, there has been a public objection to ObamaPreciMed, and it is reported that there is only Craig Venter, another big cow in the American scientific community. In fact, Venter’s original words simply say that Obama’s “public-private partnership to share information†is naive, and he has not seen any criticism of any other aspects, such as “new bottled old wineâ€, “just The irony of changing the noun.
Sixth, the possible "risk" of ObamaPreciMed, perhaps as a well-known American scientist who has been vocal about precision medicine, is blunt to the author: Obama's precision medicine has his clear scientific meaning and specific content. But the "dangerous" aspect of this formulation is that all the repetitive studies that have been stagnation for many years, stagnation, huge investment, and very little success, may be changed by "going to precision", or "new bottled old "Wine" or "borrowing the bottle of wine". Looking back at history, this may be the most important thing we should pay attention to and worth pondering.
Finally, Professor Yang Huanming believes that Obama PreciMed can be summarized as: taking DNA and HGP as the main line, taking polio as a precedent to eliminate monogenic diseases, and supporting cancer and other data with millions of people's genome and clinical information. Multi-gene disease research, changing government support and regulatory approaches, emphasizing the importance of corporate participation, and launching large-scale forward-looking projects supported by society.
"Corporate Circle" Leading Medicine Mingkang's Analysis of Accurate Medical Plan
Precision medicine is a recent hot word. Both China and the United States have recently launched their own precision medical plans. So what is precision medicine? What is the difference with the past? As the leader of the CRO, WuXi PharmaTech, who also entered the medical field, also interpreted this hot word in his WeChat public account (see the figure below).
Interpretation of precision medicine in the up-and-coming talents of the business world
Professor Pan Haisheng believes that the realization of precision medicine is a too complicated model. Every patient's situation is different. It is difficult for a doctor to have such comprehensive knowledge. Therefore, every disease needs a professional team to manage and practice. It is still in the exploration stage on a global scale. The integration of disease molecular change mechanisms, bioinformatics big data, clinical medication, professional medical knowledge, health management and other related information can truly achieve precision medicine.
Standing in the position of small and medium-sized enterprises, he also believes that the state of precision medicine is particularly supportive, and leaders and the government attach great importance to it. China has a large population and a large sample size. Many highly dedicated doctors and scientists are dedicated to exploring the disease mechanism and benefiting patients. Many diseases in China are likely to be at the forefront of the international market.
Media: Should China wait for the “precise medical†plan?
The singer praised that since the previous genomics research also has clinical application value, the scientific goal is more to decode the “天书†itself of the human genome, rather than the application; the “precise medical plan†is a new one. At the beginning, it is directly aimed at the accumulation and application of genomics technology and knowledge. If the "Human Genome Project" is a basic research, then the "precise medical plan" is the "transformation" research. After this "transformation" process, the final realization The original vision of the Human Genome Project allowed everyone to benefit from their own genomic information.
Neutralists believe that the “precise medical plan†is actually a continuation of a series of large-scale genomic research projects starting with the “Human Genome Projectâ€. Although precision medicine will be more personalized, it still cannot replace the success of existing oncology. Areas - prevention, diagnosis, screening of effective methods and treatment. Precision medicine can provide a powerful framework to accelerate its application in different fields, most notably in the field of genetic diseases and infectious diseases, and has received positive feedback in other diseases and environmental responses.
Opponents believe that since the rich countries of the United Kingdom and the United States are sequencing the genome on a large scale, this large-scale sequencing work seems to be simple and repetitive, and costly; the data of genome sequencing is not patentable; a large number of inputs cannot be fulfilled as an "economy." "Effects", then China can completely "sit and enjoy" and wait for them to publish data.
From a scientific point of view, genomic research in the United Kingdom and the United States may benefit all humans, but the genome of the yellow race differs from that of white people, and the same conclusions can be drawn from various large-scale genomic studies and clinical studies. The yellow racers need their own large-scale genomics data as a basis to do the "precise medical treatment" of the yellow racers themselves.
Source: Bio-Exploration
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