Mexico, World Leader in GenomicsWed, 09/06/2017 - 14:39
Q: How effective would a 4P (prevention, prediction, personalization and participation) approach be in Mexico, where prevention is so low?
A: Prevention should be analyzed not only through old paradigms but by thinking through new ones. Prediction, the second of the 4Ps, is weaker when based on general recommendations rather than personalized predictions generated from genetic traits, the third P. The fourth of the 4Ps is participation. It is also necessary to consider the role of insurance companies. Imagine them inserting themselves into personalized medicine and prevention, managing differentiated premium costs and even complete health-service provision systems not based on the scheme of a hospital for sick people but based on health-promotion systems entailing some elements of precision medicine. Detection and analysis methods of personalized medicine will be decreasingly invasive and increasingly automatic. This transition will be a matter of lustrums, not even decades.
Q: What obstacles stand in front of this transformation?
A: There is a technological barrier. Technologies and knowledge must mature and be applied. The lag is not often in technological advancement, but in the application of molecular diagnoses. There is a regulatory barrier too. The FDA now will no longer approve the use of drugs for cancer exclusively in the original organ but in any cancerous organ with the same gene as an impeller, which is a complete change because now the basis for cancer treatment is not the organ but a biomarker indicative of several cancers. In Mexico, where physicians prescribe more freely, physicians use molecular diagnosis to prescribe for a cancer in another organ. There is also a cultural barrier because health professionals have not yet assimilated genomic medicine and medical faculties still follow study programs that lack a genomic medicine component. With cancer, it is impossible for an oncologist to ignore genomic issues. In pharmacogenomics, precision medicine will increase drug effectiveness and reduce adverse effects. Soon, when a novel or unusual drug is prescribed or a person is born, a pharmacogenetics test will be performed and a patient’s genetic profile will last forever.
Q: Can INMEGEN train medical professionals in genomic medicine?
A: The researchers of INMEGEN are both generating knowledge and involved in educational programs. We offer between four and five courses each semester for both graduate studies and as continuous education. INMEGEN is also putting the final touches on plans for an integral course in genomic medicine and a series of specialized modules on the applications of genomic medicine and is involved in some undergraduate courses with the School of Medicine at UNAM, but they are insufficient. An obstacle we face is that specialists cannot do their main residence in genomic medicine. Physicians must conclude their main residence before moving on to study an advanced course in genomic medicine at INMEGEN. Since INMEGEN cannot offer scholarships at that level, students who take that course are usually specialized physicians with a solid income.
Q: What are INMEGEN’s priorities for the next two years?
A: Continuing and finishing the characterization of Mexican genetic diversity, applying this knowledge to the most advanced areas of genomic medicine and finding more correlations between genes and diseases, especially chronic diseases. INMEGEN has a joint project with PEMEX’s health services to develop a series of precision-medicine services and to study rare, psychiatric and metabolic diseases. INMEGEN will correlate genetic parameters with these diseases in the areas of pharmacogenomics and predisposition diagnoses to create prevention programs. INMEGEN’s Genomic Diagnosis Laboratory will continue offering a series of genetic tests, including an advanced version of genomic molecular cancer tests. There will be an incursion in the area of infectious disease through research and data collection of common diseases constituting public health issues. INMEGEN expects to provide specific services in the most mature areas of genomic medicine: cancer, pharmacogenomics and infectious disease.