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Strategies for Stratified Medicine: A Rosy Outlook for Scotland’s Wealth & Health

Posted on Oct 03, 2012 by Dr. Julie Nixon  | 0 Comments

This blogger attended an excellent event earlier this week at Edinburgh’s BioQuarter for their inaugural networking event. A distinguished panel of scientists led the discussion on personalised/stratified medicine.

Inherited genetic differences affect the body’s response to medication. Some drugs may cause side effects in one individual but not in another. Stratified medicine means looking at the genetic makeup of large groups in the population, then from this information scientists hope to be able to predict which drugs are likely to be most effective in treating disease. In the future patients may be able to take diagnostic tests to work out which drug regime would be most suited to them-this is personalised medicine.

Among the panel last night was Professor David Porteus who is one of the main collaborators in “Generation Scotland”, a multi-institution, cross-disciplinary collaboration between the Scottish University Medical Schools, associated research institutions and the NHS, which has developed a biobank of biological samples and information on health and lifestyle from 30,000 volunteers throughout Scotland.

The panel discussed why Scotland is an ideal population for the project. As well as having a genetically heterogeneous population reflecting migration patterns from different countries, Scotland has an  international reputation in using recorded medical data for epidemiological, genetic and clinical trial research. NHS Scotland provides efficient and comprehensive computerisation of routine clinical data with guaranteed patient confidentiality. And our academic institutes provide world class researchers to exploit the data. Biologics could be matched to genetic tests so the promise of opportunities for diagnostics and therapeutics is high; this could even translate into Scotland becoming a hub for diagnostic and pharmaceutical companies, with BioQuarter a key player in promoting this. BioQuarter aims to aid researchers in commercialising their work by providing a “bio-incubator” for companies and promoting collaboration.

This is an opportunity that must be grabbed. The panel also identified other key issues such as the need to build an “Innovation Ecosystem”. Framing the new technology in the public mind early on, something that Generation Scotland has done well, was important as this promotes public cooperation.  Patients are less risk averse than previously thought, a critically ill individual with a clear understanding of the risks involved might be willing to take part in a clinical trial of an “L” plated drug which perhaps could have been years away from the clinical trial phase. The NHS is a perfect setting for such trials, and unlike large pharmaceuticals the NHS has no vested interest in these new drugs other than improved patient health. As a result drug trials could be more complete and open. Lowering regulation thresholds, but still maintaining safety, could result in quicker treatments and drugs faster to market, an attractive proposition for investors.

Let’s not forget that as less drugs go to market, the costs of bringing these drugs to market are rising. Personalised medicine could provide more drugs to the public at a faster pace with reduced costs, for example identifying particular drugs for genetically suitable groups of individuals eliminates certain drugs from the trial as non starters. The genetic background of a patient could predict whether he or she may have adverse side effects to a drug. But there may be individuals with different genetic makeup that could benefit from the same drug, perhaps previously eliminated as a candidate before reaching the market.

So can medicine be redefined and made commercial?  Through targeted drug clinical trials it was proposed costs could go down from £50K to even £5K. The NHS could facilitate lots of trials with strategic drugs efficiently and cheaply. Risk would reduce for potential drug developers, regulators could rethink the current regulations in place and investors might rethink the potential in pharmaceuticals and diagnostics. For both Scotland’s health and economy, let’s hope this happens!

Julie Nixon

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