Personalised Medicine

Contributed by Dr. Cheryl Kam MBBS BSc GDFM

Most of us are familiar with the prevailing high-volume health care environment where most medical treatments are designed for the ‘average patient’ in a one-size-fits-all approach.  This is successful for some patients, but not for many others.  For example, SSRIs (Selective Serotonin Reuptake Inhibitor, a class of widely used anti-depressants) simply do not work for a whopping 38% of people diagnosed with depression.

We are all unique. From our eye colour, to our fingerprints, to our genetic makeup.  Why then, should we expect to all have the same response to the same drugs or treatment?

The answer to who will or will not respond to a certain drug or treatment might just lie in our DNA.

DNA testing

Today, the sequence of the four chemical building blocks that comprise DNA – coupled with telltale proteins in the blood – enable more accurate medical predictions. These include whether an individual is developing an illness now, or will develop it years in the future; whether they will respond positively to treatment, or will suffer a serious reaction to a drug.

Precision medicine, sometimes known as personalised medicine, is an innovative approach to disease prevention and treatment that takes into account differences in people’s genes, environments and lifestyles.

Is there more we can do?

A large number of molecular biomarkers related to gene mutations can be identified through genomic studies. Since the completion of the Human Genome Project (HGP) in 2003, there has been a better understanding of which genes link to certain traits or disease.

But are we destined to live out what our genes say about us?  Is there a way out of “bad” genes?

Changing your genetic destiny with epigenetics.

The discovery of what our genes say about us has created a new field within medicine called epigenetics. Epigenetics is the study of these chemical reactions and the factors that influence them.  These factors are inheritable and, while affecting whether a gene is expressed or silenced, do not alter the actual DNA.

As we grow and develop, carefully orchestrated chemical reactions are able to activate and deactivate parts of the genome at strategic times and in specific locations. The epigenome dynamically responds to the environment, and the study of epigenetics addresses this.

Examples of mechanisms that produce such changes are DNA methylation and histone modification, each of which alters how genes are expressed without altering the underlying DNA sequence.

These are concepts that profoundly shift our understanding of health and disease and of the “nature vs. nurture” debate—particularly when nutrition enters the picture.

We now know that stress, diet, behaviour, toxins, and other factors regulate gene expression, and targeted interventions this area can indeed change the course of what your DNA might say about you.

Contributed by Dr. Cheryl Kam MBBS BSc GDFM

Dr. Kam is a London trained family physician practising at Mint Medical Centre, Harbourfront Tower 1.

She has a special interest in preventative medicine, epigenetics and integrative medicine.

She takes care of entire families, and is known best for women’s health issues, child health, complex cases, and athletes wishing to improve their performance.



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