28 September 2015
ByAppeared in BioNews 821
NHS England's national medical director, Sir Bruce Keogh, has outlined how the organisation's approach to personalised medicine will develop over the coming years and expand beyond the work of the 100,000 Genomes Project (100KGP).
The strategy aims that, instead of treating patients on the basis of a set of symptoms, doctors will increasingly use emerging diagnostic technologies and genomics to detect the underlying causes of disease. By targeting interventions to the patients most likely to respond, the strategy is intended to lead to more effective and efficient treatment.
It also involves a greater role for preventive medicine, with the hope that diseases can be predicted and prevented, or else detected years earlier than they would be currently.
In a paper to the Board, Sir Bruce said that moving away from a 'one size fits all' approach to treatment would allow NHS England to become efficient and improve patient outcomes.
'Adopting a personalised medicine approach will allow the most appropriate intervention for the individual to be used, reducing costs and preventing adverse reactions in those who will not respond to certain treatments,' he writes.
'Given the current NHS drugs budget is over £12 billion, using diagnostics to guide treatment interventions is of fundamental importance to NHS England as a commissioning organisation.'
Proposals for implementation include developing the infrastructure of the NHS, including a national network of genomic testing laboratories emerging from the 100KGP, and greater harnessing of technology.
Professor Sue Hill, chief scientific officer, says that the integration of diagnostic, therapeutic and genetic data will also be essential.
'The NHS carries out more than a billion diagnostic tests every year, but we are only just learning the potential of all this information coming together to form an integrated picture over time – particularly when coupled with genomic sequence data,' she writes.
Professor Hill added: 'By taking a strategic approach to developing a more personalised approach to medicine, building on the learning coming through from NHS Genomic Medicine Centres, this country will be one of the most scientifically advanced in the world in use of genomics.'
However, Dr Stuart Hogarth, a senior research fellow from King's College London, said that while reorganisation of infrastructure to improve the quality of molecular diagnostic testing in the NHS 'seems very sensible' some of the plans may be ahead of the science.
'The very bold claims being made are not supported by many concrete examples,' Dr Hogarth told BioNews. 'We still have very few targeted therapies where the target population is defined using a companion diagnostic, and they are nearly all cancer drugs. Given that the front-line therapies in cancer are still surgery and radiotherapy, this is hardly a revolution in medicine.'
He also said that some of the assumptions made in the paper, such as that preventive therapy will be 'low cost', may not be a given.
'The same can be said for the promise of earlier detection – a laudable aim, but experience has taught us that screening needs to be rigorously evaluated to ensure that the benefits outweigh the harms,' he said.
NHS England will next be developing a five-year work programme, an investment plan and a review of potential cost savings and efficiency gains to be presented to the Board.