{"id":45501,"date":"2019-09-06T12:43:07","date_gmt":"2019-09-06T11:43:07","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=45501"},"modified":"2019-09-06T17:33:10","modified_gmt":"2019-09-06T16:33:10","slug":"jane-wilcock-personalised-and-precision-medicine-definitions-and-distinctions","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/09\/06\/jane-wilcock-personalised-and-precision-medicine-definitions-and-distinctions\/","title":{"rendered":"Jane Wilcock: Personalised and precision medicine\u2014definitions and distinctions"},"content":{"rendered":"<p class=\"standfirst\"><span style=\"font-weight: 400\"><i>The term &#8220;personalised medicine&#8221; is being applied to two distinct medical practices, the healthcare community needs to end the confusion with new terminology, says Jane Wilcock<\/i><\/span><\/p>\n<p class=\"standfirst\"><!--more--><\/p>\n<p><span style=\"font-weight: 400\">As healthcare professionals we talk about personalised care, person-centred care, personalised medicine, individualised care and precision medicine. These have distinct meanings, but are often confused as the same thing. By confusing these terms, NHS policy makers, researchers, healthcare workers, and the public miscommunicate. Patients and their doctors need the same lexicon, particularly as patients gain access to their digital personal health records.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Personalised care refers to a wide holistic discussion with the patient, and at times their loved ones, which considers the patient\u2019s context. It requires specific consultation and management skills.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Personalised medicine describes a targeted treatment based on a patient\u2019s tumour or genomic markers. In personalised medicine and cancer care it is easy to see how holistic management around the treatment of cancer, sometimes including end of life care, can be confused with specific therapeutic strategies if the terms are not better distinguished.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">A look through recent NHS reports and documents shows how these terms are used interchangeably.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Firstly, there is a generalist, holistic definition of personalised care. Helen Stokes-Lampard, chair of The Royal College of General Practitioners (RCGP), <\/span><a href=\"https:\/\/www.rcgp.org.uk\/clinical-and-research\/about\/clinical-news\/2017\/november\/personalised-care-dealing-with-50-per-cent-of-gp-appointments.aspx\"><span style=\"font-weight: 400\">writes about personalised care<\/span><\/a><span style=\"font-weight: 400\"> offering a \u201cperson-centred<\/span> <span style=\"font-weight: 400\">approach to give people more choice and control in their lives, by providing an approach that is appropriate to the individual\u2019s needs.\u201d Likewise, <\/span><a href=\"https:\/\/www.hee.nhs.uk\/our-work\/person-centred-care\"><span style=\"font-weight: 400\">Health Education England<\/span> <span style=\"font-weight: 400\">states<\/span><\/a><span style=\"font-weight: 400\"> \u201c<\/span><span style=\"font-weight: 400\">Being<\/span> <span style=\"font-weight: 400\">person-centred<\/span> <span style=\"font-weight: 400\">is about focusing care on the needs of the individual. Ensuring that people&#8217;s preferences, needs, and values guide clinical decisions, and providing care that is respectful of and responsive to them<\/span><i><span style=\"font-weight: 400\">.\u201d <\/span><\/i><a href=\"https:\/\/www.nationalvoices.org.uk\"><span style=\"font-weight: 400\">National Voices, a coalition of charities,<\/span><span style=\"font-weight: 400\">3<\/span><span style=\"font-weight: 400\"> states<\/span><\/a><span style=\"font-weight: 400\"> \u201cWe want person-centred care: people having as much control and influence over their care as possible\u201d.\u00a0 <\/span><a href=\"https:\/\/www.longtermplan.nhs.uk\/wp-content\/uploads\/2019\/01\/nhs-long-term-plan.pdf\"><span style=\"font-weight: 400\">The NHS Long Term plan repeatedly proposes<\/span><\/a><span style=\"font-weight: 400\"> increased person-centred care, in choice and control with personal health budgets and personal digital records to individualise people\u2019s care. <\/span><a href=\"https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2019\/01\/universal-personalised-care.pdf\"><span style=\"font-weight: 400\">NHS England\u2019s Universal Personalised Care publication talks about<\/span><\/a><span style=\"font-weight: 400\"> delivery of personalised care and states \u201cPersonalised care means people have choice and control over the way their care is planned and delivered, based on \u2018what matters\u2019 to them and their individual strengths, needs and preferences.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">However, the NHS Long Term Plan also alludes to another definition of \u201cpersonalised care.&#8221; The plan mentions identifying a person\u2019s genome, or tumour characteristics, to provide targeted therapies with the aim of improving outcomes for specific subpopulations of people. This is not the widely used definition of shared decision making, or holistic consultation skills, but rather it is about offering more personalised therapeutic options using genomics.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">An <\/span><span style=\"font-weight: 400\">NHS England report,<\/span><a href=\"https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2016\/09\/improving-outcomes-personalised-medicine.pdf\"> <i><span style=\"font-weight: 400\">Improving Outcomes Through Personalised Medicine<\/span><\/i><span style=\"font-weight: 400\">, states that <\/span><\/a><span style=\"font-weight: 400\">\u201cp<\/span><span style=\"font-weight: 400\">ersonalised medicine<\/span> <span style=\"font-weight: 400\">is a move away from a \u2018one size fits all\u2019 approach to the treatment and care of patients with a particular condition, to one which uses new approaches to better manage patients\u2019 health and targets therapies to achieve the best outcomes in the management of a patient\u2019s disease or predisposition to disease.\u201d<\/span> <span style=\"font-weight: 400\">\u00a0This document outlines the <\/span><span style=\"font-weight: 400\">genomic advances in creating personalised medicine, and discusses the interaction between environment, lifestyles and genomics, including technology advances like \u201cwearables\u201d to improve personal outcomes and how these can be embedded into mainstream medicine. <\/span><a href=\"https:\/\/www.cancerresearchuk.org\/get-involved\/donate\/become-a-major-donor\/how-you-can-give\/the-catalyst-club\/personalised-medicine\"><span style=\"font-weight: 400\">Cancer Research UK states<\/span><\/a><span style=\"font-weight: 400\"> that \u201c<\/span><span style=\"font-weight: 400\">Personalised medicine classifies tumours according to their genetic make-up instead of where they grow in the body, such as \u2018prostate\u2019 or \u2018breast\u2019 cancer.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The confusion about how this terminology is applied, occurs across the Atlantic as well. The <\/span><span style=\"font-weight: 400\">Mayo Clinic in the USA has a <\/span><a href=\"http:\/\/mayoresearch.mayo.edu\/center-for-individualized-medicine\/about-the-center.asp\"><span style=\"font-weight: 400\">Center for Individualized Medicine which states<\/span><\/a><span style=\"font-weight: 400\"> \u201c<\/span><span style=\"font-weight: 400\">individualized medicine, also known as personalized medicine or precision medicine, means tailoring diagnosis and treatment to each patient to optimize care\u2026 We&#8217;re using your unique genetic code to more effectively and precisely diagnose, treat, predict and eventually prevent disease.\u201d The term individualisation however, also appears in publications on medications, meaning to tailor medicines according to evidence and to our patients\u2019 wishes.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Also in the USA, <\/span><a href=\"https:\/\/ghr.nlm.nih.gov\/primer\/precisionmedicine\/precisionvspersonalized\"><span style=\"font-weight: 400\">The National Research Council<\/span><span style=\"font-weight: 400\"> tries to clarify<\/span><\/a><span style=\"font-weight: 400\"> the situation but for different reasons, by stating that \u2018\u2018\u2018p<\/span><span style=\"font-weight: 400\">ersonalized medicine\u2019 is an older term with a meaning similar to \u2018precision medicine.\u2019 However, there was concern that the word \u2018personalized\u2019 could be misinterpreted to imply that treatments and preventions are being developed uniquely for each individual; in precision medicine,<\/span> <span style=\"font-weight: 400\">the focus is on identifying which approaches will be effective for which patients based on genetic, environmental, and lifestyle factors. The Council therefore preferred the term \u2018precision medicine\u2019 to \u2018personalized medicine.\u2019\u201d<\/span> <span style=\"font-weight: 400\">\u00a0A distinction is made that personalised medicine is not totally personalised but identifies subgroups of patients.<\/span><\/p>\n<p><span style=\"font-weight: 400\">It would seem safer and clearer to describe these new advances more exactly as pharmacogenomics, <\/span><a href=\"https:\/\/ghr.nlm.nih.gov\/primer\/genomicresearch\/pharmacogenomics\"><span style=\"font-weight: 400\">defined by the USA National Library of Medicine<\/span><\/a><span style=\"font-weight: 400\"> as \u201cthe study of how genes affect a person\u2019s response to particular drugs\u201d and secondly as theranostics<\/span> <span style=\"font-weight: 400\">(or theragnostics). <\/span><a href=\"http:\/\/theranostics.com.au\/what-is-theranostics\/\"><span style=\"font-weight: 400\">Theranostics Australia states<\/span><\/a><span style=\"font-weight: 400\"> that \u201c<\/span><span style=\"font-weight: 400\">Theranostics uses specific biological pathways in the human body, to acquire diagnostic images and also to deliver a therapeutic dose of radiation to the patient.&#8221;<\/span><\/p>\n<p><span style=\"font-weight: 400\">In my view &#8220;personalised medicine&#8221; should be dropped as a definition for therapeutic and investigative advances. An improvement is the use of the term &#8220;precision medicine&#8221;, although &#8220;pharmacogenetics&#8221; and &#8220;theranostics&#8221; could be adopted as non-confusing terminologies and these terms better define the new branches of medicine. In this way, primary and secondary care specialists, social care workers and the public, and our patients would all understand the matter being discussed. I would ask national and international bodies to agree distinct terminologies and definitions, which clearly distinguish personalised patient-centred care from personalised or precision medicine by widely using terms such as pharmacogenetics and theranostics.<\/span><\/p>\n<p><i><span style=\"font-weight: 400\"><strong>Jane Wilcock<\/strong> is a GP in Salford, chair of the RCGP overdiagnosis group, and vice chair RCGPNWE faculty.<\/span><\/i><\/p>\n<p><strong>Twitter: <\/strong><a href=\"https:\/\/twitter.com\/janewilcock\"><span style=\"font-weight: 400\">@janewilcock<\/span><\/a><\/p>\n<p><span style=\"font-weight: 400\"><strong>Competing interests:<\/strong><\/span><i><span style=\"font-weight: 400\"> None declared<\/span><\/i><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The term &#8220;personalised medicine&#8221; is being applied to two distinct medical practices, the healthcare community needs to end the confusion with new terminology, says Jane Wilcock [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/09\/06\/jane-wilcock-personalised-and-precision-medicine-definitions-and-distinctions\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":45502,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[],"class_list":["post-45501","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guest-bloggers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - 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