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“The medicine always has been personalized”In the sense that it is focused on a person, a patient, trying to take care of him and improve him. This is how the report explains it Personalized Medicine in Latin America: Universalizing the Promise of Innovation, prepared by The Economist Intelligence Unit (EUI), division of research and analysis of The Economist Group, sister company of The Economist newspaper.
Today there are three developments that are radically increasing the ability of physicians to offer health care plans. prevention and treatment more and more personalized. Is what is called precision medicine.
Those developments are: a growing ability to gather and store information in an integrated manner, a growing ability to gather information from patients to molecular level and analytical tools increasingly powerful to filter this information.
This report, which was sponsored by Roche Foundation Medicine, places Uruguay at level one of the three levels in which countries are classified with regard to personalized medicine.
It is the best level and it means that the country is “ready to decide”If you want to create a comprehensive and holistic approach.
In other words, it has appreciable elements of the support framework, but they are held back by important gaps.
In addition to Uruguay, level one includes Argentina, Brazil, Colombia and Costa Rica.
Tier two countries (Chile and Mexico) have significant strengths, but less than those of tier one countries. Therefore they need to be in the process of “strengthening the foundations”.
Meanwhile, level three countries (Ecuador and Peru) have relatively few resources from which personalized medicine can be used. They are “starting the journey.”
To prepare this report, a literature review was carried out and experts were consulted. In Uruguay, he spoke with Diego Touyá, responsible for Oncology department of the Maciel Hospital, and with Rachel Paniagua, vice president of the patient organization give me your hand. The objective was to describe the current and future trends of the systems of personalized medicine, providing an assessment of the current state, barriers, enabling factors and areas of opportunity in the countries studied.
Recommendations beyond the pandemic
The research was conducted before the crisis of the COVID- 19, so it does not directly address the pandemic. It is clarified that it does not affect its conclusions either.
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The situation in Latin American countries today
* Political will remains weak.
* Policies on individual elements of personalized medicine are common, but a holistic view is lacking.
* Regulatory bodies lack the capacity to support needed innovation.
* In general, health professionals are not aware of the potential of this medicine.
* The general knowledge of the population about this medicine is scarce, but when there are treatments, patients and their families are committed.
* Patient data situation improves, but much remains to be done.
* The genetics laboratory facilities are a project in development.
* Financing will remain a challenge until this medicine is seen as an investment and not a cost.
* Support should be given to Health Technology Assessment (HTA) bodies.
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Four pillars.
The personalized medicine uses the application of technological advances to facilitate the correct diagnosis and the medically correct for him suitable patient in the right moment. For this, it promises an early and accurate diagnosis, remote monitoring and care, improved risk management, a move away from the “one-size-fits-all” model, personalized treatment options and individualized care plans for each patient.
The report identifies four pillars where systems should work to move from precision medicine to personalized medicine. They are: governance, which includes political will, strategy and regulations; awareness and attitudes, both of the workforce and of the patients and the population; infrastructure (information systems and data collection, and laboratory tests); and financial management.
The concept of personalized medicine means a paradigm shift in health systems. It would be a revolution in how patients were treated before and how today, with all the technological advance and the information available, it can be attended in a more personalized and different way.
Points to which legislators are called to action
* A consistent governance approach to personalized medicine is needed so that appropriate interventions can be applied easily and quickly.
* There is a need to increase public and specialist understanding of the mechanisms, possibilities and limitations of personalized medicine.
* Countries should consider how to improve medical information and laboratory infrastructure to facilitate the adoption of personalized interventions.
* Officials must put aside the prejudices that personalized medicine is too expensive and invest in Health Technology Assessment processes to ensure informed decision making.
* The construction of a frame of reference will not only support personalized medicine, but will improve the function of the health system as a whole.
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Application examples.
The greatest progress in personalized medicine has occurred more than anything in the oncological diseases and the rare diseases.
In the oncological case it is known, and it is part of the advances in personalized medicine, that no two cancers are the sameRather, each tumor is different because it is the result of one or more alterations in the DNA of each cell. This causes the cell to grow out of control and what is known as a tumor forms.
Traditionally, cancer was classified according to the organ where it originated – breast cancer, lung cancer, etc. – and the treatments were determined by that organ. However, with all current innovation there is the ability to analyze and treat each tumor, understand all the molecular information and be able to identify a treatment that is much more precise and that is directed to that tumor.
In addition, it is possible to compare and group which are the molecular alterations found in each of these cells, which can be in many types of cancers even though they are in different organs.
The breast cancer is a good example because today we know that there is not a single cancer of this type. There is the case of HER2 positive, which is very aggressive and caused by abnormal activity of the HER2 protein.
Thanks to personalized medicine, specific drugs have been developed for the treatment of this subgroup of patients who suffer from it.
Although this report was prepared before the start of the pandemic of the COVID-19, it is possible to deduce that personalized medicine is also very useful for this type of communicable diseases. In the case of Uruguay, it could be seen in the development of the mobile application coronavirus.uy, which showed how an amount of patient data can be collected that, when analyzed, improves decisions made along the way.
Uruguay is well positioned, but lacks
According to the report Personalized medicine in Latin America, Uruguay is at the level “ready to decide”. To generate a comprehensive approach, it is necessary to advance on the issue of governance (political will, strategy, regulations), but there is already great progress on the issue of infrastructure and information management.
Today in our country there are no comprehensive examples of personalized medicine, but there are micro-examples that have shown how the approach has been expanded and how it has been incorporated into decision-making.
One is the Neonate Research Lawl, thanks to which Uruguay is the first country in Latin America to carry out a free screening of all newborns to look for asymptomatic diseases.
Another micro-example is the coverage of high-cost technologies through the National Resource Fund for therapies that require predictive genetic studies.
In addition, today Uruguay is an example at the regional level regarding the entire issue of electronic medical record. With regard to infrastructure, in Uruguay there is a lot of implementation and progress. There are improvements in the laboratories, but there is still a lack of capacities to serve them in a better way (certain diagnoses that could be processed here are still sending samples abroad).
Refering to financial administrationUruguay is recognized as having succeeded in generating innovative payment-for-results agreements, for example through the National Resource Fund. The technology assessment team of the Ministry of Public Health has been innovative, but the creation of an independent health technology assessment agency foreseen in the latest budget law has yet to be created.
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