The Hopeful Future of Precision Medicine

Many of us have experienced the pitfalls of a “one-size-fits” all approach to medicine, where physicians prescribe treatment for the “average patient” instead of the one sitting in front of them. By not accounting for the variability in genes, environment, and lifestyle that are often so closely tied to health and illness, treatments end up falling short and sometimes do more harm than good. Fortunately, the “precision medicine” movement, which takes into account the patient’s unique characteristics when prescribing treatment and prevention strategies, has gained traction in recent years.

In 2015, President Obama funded the Precision Medicine Initiative to ensure that researchers could focus on creating efficient and effective ways to integrate more personalized treatment plans into the current healthcare and medical system. This year, we’re excited to have some of the front-runners in the precision medicine movement on the TEDMED stage!

Photo credit: Bryce Vickmark. Image provided by PanTher Therapeutics.

Photo credit: Bryce Vickmark. Image provided by PanTher Therapeutics.

An immediate goal of the Precision Medicine Initiative is to apply this approach to catalyze cancer research. While we have learned more about cancer prevention, detection, and treatment in the past 2 decades than we have learned in the previous centuries, we still haven’t found a treatment that doesn’t harm the patient in the process. The TEDMED 2016 Hive company PanTher Therapeutics is working to change this. As their CEO Laura Indolfi puts it, “it seems very counterintuitive to have a whole body treatment to target a specific organ.” The company is studying the precise delivery of existing, already proven chemotherapy agents directly onto the tumor using flexible plastic patches for consistent, slow release over time. PanTher is completing pre-clinical testing prior to initiating human trials for patients with pancreatic cancer, but hope to apply the same technique to treat other forms of cancer in the near future.

Another goal of the Precision Medicine Initiative is to harness the power of data to highlight trends about disease and health, in search of more effective treatments. This is precisely what Andrew A. Radin and his team at twoXAR are working on. The TEDMED Hive organization has produced efficacy signals in preclinical studies in multiple diseases. To date, twoXAR has completed over 75 disease prediction models and has 9 drug discovery collaborations, including both rare and common conditions.

Ultimately, the Precision Medicine Initiative aims to translate this method of prevention, treatment and care across all fields of health and healthcare. One area where precision medicine could have a measurable impact is in the study of neurodegenerative diseases, due to the relationship between genetics and neurodegenerative disease. The TEDMED 2016 Hive organization Denali Therapeutics is researching the genetic causes and biological processes underlying neurodegenerative disease and using this information to create targeted treatments for Alzheimer’s disease, Parkinson’s disease, ALS and other neurodegenerative diseases. Led by Chief Medical Officer, Carole Ho, Denali’s research team has identified multiple drug targets that could lead to breakthroughs in the treatment of Parkinson’s and Alzheimer’s disease.

TEDMED 2016 Hive organization Frequency Therapeutics is looking to uncover the body’s hidden biological potential to heal itself. Led by Co-Founder, President and CEO, David Lucchino, Frequency Therapeutics is developing small molecule drugs that activate progenitor cells within the body to restore healthy tissue in a precise and controlled way. With recent discoveries in stem and progenitor cell biology, Frequency Therapeutics is creating therapies that could reverse sensory hearing loss by targeting specific hair cells within the inner ear. Their approach is promising not just for the almost 1 billion people across the world who are affected by hearing loss, but for the potentially large impact on other diseases as well.

Image provided by Charles Chiu.

Image provided by Charles Chiu.

Using the precision medicine approach would also enable us to prevent the spread of disease much more efficiently. With the recent Ebola and Zika outbreaks, many are wondering how we can stop the spread of similar outbreaks in the future. Charles Chiu, an infectious disease physician and researcher, is pioneering the clinical implementation of a tiny next-generation sequencing device from Oxford Nanopore Technologies that could drastically change the way we respond to the next deadly bug. This device “can detect all pathogens – virus, bacteria, fungus, parasite known or unknown – in a single test,” says Chiu, and can do so in a matter of hours and in remote, low-resource settings. By using this device, we could decrease the time it takes to find diagnoses, which would help curb the spread of outbreaks and enable clinicians to provide timely and effective treatments for their patients.

Thanks to these extraordinary innovations, the future is looking brighter already. From preventing pandemics; to defeating neurodegenerative diseases; to curing and preventing hearing loss; to accelerating drug discovery; and creating a new therapy for cancer, each of these TEDMED Speakers and Hive innovators are working to ensure that the goals laid out in the Precision Medicine Initiative become a reality for generations to come.

With these exciting breakthroughs just around the corner, we are excited to hear more about these inspiring innovations as these Speakers and Hive entrepreneurs take the stage at TEDMED 2016. Register today to join us in Palm Springs, CA, this November 30 – December 2.

Gaining Wisdom in the Family, Workplace, Community, and Society

By guest contributor and TEDMED speaker, Dilip V. Jeste, MD.

Wisdom is a complex human trait. It includes several components: 1) ability to make appropriate social decisions, 2) overall happiness coupled with control over emotions, 3) helping others through compassion and altruism, 4) self-knowledge and ability to reflect, 5) humility to know the limits of one’s knowledge, and 6) decisiveness when needed. I believe there is an evolutionary purpose to wisdom – it enhances individual well-being along with one’s usefulness to society. Wisdom includes much more than intelligence – that is why wise people are typically intelligent, but not all intelligent people are wise!

The basic concept of wisdom is similar across the globe and has been essentially unchanged over the known history of human behavior. However, there are some cultural differences. For example, spirituality would be considered an essential component of wisdom in some cultures, but not in others. Aging is associated with increased wisdom. As I mention in my TEDMED talk, wisdom likely compensates for the loss of fertility and of physical health that accompanies aging, and allows wise grandparents to transfer their life knowledge to younger generations.

Aging is associated with increased wisdom. (Image: Shutterstock.)

Aging is associated with increased wisdom. (Image: Shutterstock.)

How do these concepts of individual wisdom apply to the wisdom of larger groups such as a family, workplace, sports team, community, or society? A large majority of the members of a wise group would have high levels of wisdom; however, it is not necessary for all members of the group to be particularly wise. Indeed, it is more useful to have diversity in multiple forms including some individuals with varied levels of wisdom. A critical necessity is having wise leadership. Openness to new experience is an essential criterion for group wisdom, but not necessarily for individual wisdom.

A wise workplace will be productive and creative, but will also be happy. Businesses that focus solely on sales or profits would not be considered wise if they require constant or unhealthy competition among their members. Similarly, a collegiate sports team that seeks to win at all costs rather than to ensure high graduation rates and a milieu of collaboration, cooperation, and empathy toward less gifted competitors, is not a wise team, regardless of the number of championships it wins. The trick is in balancing a drive for excellence and hard work, with grace in defeat and magnanimity in victories.

How can wisdom be fostered in such groups? An important means would be through behavioral strategies. Wise parents seek to raise their children to be better decision makers, less impulsive, and with more control over their emotions, more caring of their siblings and friends, while avoiding egotism or ambivalence, and promoting self-reflection. Successful parents do not rely only on teaching their children to embrace these values; they also act as role models of such behaviors by reinforcing positive behaviors and not rewarding untoward ones.

Psychiatrists, psychologists, and other therapists and counselors seek to modify the high-risk behavior of persons with mental illnesses, such as delusions, aggression, or suicidal depression, with cognitive behavior therapy (CBT). The focus of CBT is on 3c’sCatch the untoward behavior, Check that it is unhelpful, and then Change it to helpful behavior. The same principles can be applied to replace unwise behavior with wise behavior at workplace, on sports teams, and in various businesses. While employees who sell the largest volume of products can be rewarded, so too should be rewarded the people who help develop a collegial milieu which increases other workers’ level of happiness leading to greater overall productivity. For example, in basketball, they would reward players with the most assists along with those who scored the most points.

The responsibility for making a group wise lies primarily with its leadership, which then makes sure that the culture promoting wisdom trickles down the chain of command, and reaches the workers on the lowest rung. Ultimately, promoting group wisdom is not merely a nice thing to do– it is a smart thing to do!

 



Dilip Jeste

 

In his TEDMED talk, geriatric psychiatrist and neuroscientist Dilip V. Jeste reveals how our brains compensate for physical aging, and discusses an unexpected evolutionary advantage to growing old–gaining sage wisdom–which holds great promise to benefit society as a whole. Watch Dilip’s talk here.

References:

Jeste DV and Vahia I: Comparison of the conceptualization of wisdom in ancient Indian literature with modern views: Focus on the Bhagavad Gita. Psychiatry 71:197-209, 2008.

Meeks TW and Jeste DV: Neurobiology of wisdom: An overview. Archives of General Psychiatry 66:355-365, 2009.

Jeste DV and Harris JC: Commentary: Wisdom – A neuroscience perspective. Journal of the American Medical Association 304:1602-1603, 2010.

Jeste DV, Ardelt M, Blazer D, Kraemer HC, Vaillant G, and Meeks T: Expert consensus on the characteristics of wisdom: A Delphi Method study. Gerontologist 50:668-680, 2010.
Bangen KJ, Meeks TW and Jeste DV. Defining and assessing wisdom: A review of the literature. American Journal of Geriatric Psychiatry 21:1254-1266, 2013.

Jeste DV and Oswald AJ. Individual and societal wisdom: Explaining the paradox of aging and well-being. Psychiatry 77:317-330, 2014.

Thomas ML, Bangen KJ, Ardelt M, Jeste DV. Development of a 12-item abbreviated three-dimensional wisdom scale (3D-WS-12): Item selection and psychometric properties. Assessment 24, 2015.

Meeks TW, Cahn R, and Jeste DV: Neurobiological foundations of wisdom. In Siegel R, Germer C (eds.): Wisdom and Compassion in Psychotherapy. New York, NY: Guilford Press. pp. 189-202, March 7, 2012.

Sanders JD, Meeks TW and Jeste DV: Neurobiological basis of personal wisdom. In Ferrari M, Westrate MN (eds.): The Scientific Study of Personal Wisdom. New York, NY: Springer. pp. 99-114, 2013.