Economics Of Personalized Medicine

These days, you will read various articles going round and round about how personalized medicine could possibly prove to be a boon for medical sciences in terms of diagnosis and treatment. While on the other hand you will find many expressing their disappointment about how it hasn’t lived up to its promise pop up.

But a more interesting question is why exactly is personalized medicine such a big challenge?

The reasons might seem obvious — genes are really very complex and it’s hard to get enough people to study any particular target. A disease in which personalized therapy has been touted, probably results from a combination of many genetic mutations and it very difficult to deduce which one to blame.

Once we get to know the mechanics of personalized medicine, various questions tend to arise in our minds, like – will it work for us? If yes, then how? But the most important of them all is whether it really is worth our time and money?

First, let us throw some light on some of the many reasons why personalized medicine seems so tricky;

  • It is very hard to know which mutations are actually causing the disease and which are passive abnormalities that just happen to be present with no connection to the disease at all. For example, most patients with advanced cancer have p53 mutations. Right now, there is no drug that targets p53, and there’s no saying that taking aim at p53 will be useful.
  • Responses to the targeted therapy are often short-lived and it’s not easy to move these into meaningful extensions for healthy survival.
  • When you target one abnormality or pathway, cells might develop another means of growth, a process also known as treatment resistance.
  • Gene sequencing costs about $1,000 per patient, but handling and storage could increase the cost up to $10,000.


Now having stated the above issues, one cannot simply ignore the need to find better ways for patients to take care of themselves and better ways for physicians to help them do this. Today, most of the doctors continue to practice traditional trial-and-error medicine. In contrast, personalized medicine uses much more refined diagnostic testing to identify the exact cause of disease. Then, to select the best treatment and determine the right dosage, doctors who use the personalized medicine approach take into account the patient’s unique physiology, if applicable, of the tumor, virus, or bacteria; and the patient’s ability to metabolize particular drugs.

What really is hindering the transition from trial-and-error medicine to personalized are the following issues-

  • The pharmaceutical industries follow their blockbuster model, which focuses on developing and marketing drugs for as broad a patient population as possible and it discourages the development of therapies that aim at smaller subpopulations and the diagnostic tests that can identify them.
  • A regulatory environment that causes too many resources to be dedicated to phase-three clinical trials and too few to monitoring and assessment after the U.S. Food and Drug Administration has approved a drug.
  • The dysfunctional payment system, which pays physicians for completing procedures and prescribing drugs rather than for early diagnosis and prevention.
  • Physician behavior that is deeply rooted in trial-and-error medicine.


We need to consider and implement some straight forward and some complex solutions to overcome the aforementioned barriers, in a prudent manner.

Transforming pharmaceutical giants:

Big pharmaceutical companies can take three steps to speed the introduction of personalized medicine,

  • Abandon the blockbuster business model,
  • Forge alliances with diagnostic companies, and
  • Step up efforts to communicate the safety and efficacy advantages of targeted therapies.

 In long terms, the targeted drug business model would increase sales and profits for several reasons:

  • Once a highly effective therapy for a disease is available, more of the affected patients visit their physicians, who will then be aware of and willing to provide the treatment.
  • If a pharmaceutical company can demonstrate that its drug lowers the overall cost of treating a subpopulation with a disease, private and government insurers will be willing to pay for the diagnostic test and to pay a higher price for the drug treatment.
  • Since clinical trials now consume more than half the money spent on drug development, focusing clinical trials on targeted subpopulations would decrease their size, duration, and cost.

Given the trends, large pharmaceutical companies have little choice but to change. Those that stick with the blockbuster model face a frustrating future of declining sales and profits.

Role of FDA:

  • The FDA should motivate pharmaceutical companies to develop diagnostics and targeted drugs together.
  • The agency needs to implement practical regulations that continue to encourage industry innovation but maintain high standards of quality. 

Paying for benefit:

The cost of diagnostic tests might be high initially, but that pales in comparison with the potential benefits that tag along with personalized medical care.

When you have an expensive drug, rather than giving it to everybody, the act of individualizing that therapy will actually reduce the overall cost. If we increase the cost but have better outcomes, people are more likely to accept the change.

Changing physicians’ habits:

To get physicians accustomed to personalized medicine, medical schools must focus on genomics, diagnostic testing, and targeted therapies. This change alone will play a critical role in moving personalized medicine into mainstream practice.

The slow progress of personalized medicine in the past years could be discouraging, but it’s not very surprising given how complex of the health care system actually is. Given the higher stakes involved in personalized medicine—people’s lives and the viability of health care systems—it would be unreasonable to expect the widespread adoption of personalized medicine to happen swiftly.


Personalized medicine: Will it bend the cost curve down — or up?

The Many Reasons Why Personalized Medicine Is So Tricky

Gene Therapy: The Future Of Personalised Healthcare

                                                     Understanding Gene Therapy: Proteins And Their Roles

Proteins are responsible for a multitude of cellular functions that are crucial to the survival of cells and the organs they populate. They are produced by a process called translation. It is built based on the blueprint, or code, that outlines its structure. This code is found in the genes, also known as DNA. Therefore, defective genes cause malfunctions in metabolic pathways, hence diseases. When either too much or too little of a certain protein is produced or even when a defect in the production process occurs, it leads to a protein being formed incorrectly. And hence, these malfunctions lead to various genetic diseases.

If the precise code for making the protein is known, doctors can synthesize it in a test tube and then deliver it into the patient’s cells. Various advancements in the fields of Gene Therapy have led to successful treatment of many genetic disorders.


What Is Gene Therapy? 


Merriam-Webster’s Collegiate Dictionary defines gene therapy as the insertion of normal or genetically altered genes into cells usually to replace defective genes especially in the treatment of genetic disorders. By using gene therapy, we can go to the base of the disorder instead of use conventional medicines only to alleviate the symptoms.


Technical Aspects


There are three methods used to deliver the genetically altered material.

  1. Retroviruses or Retrotransposons: Retroviruses are viruses that can transfer their own genetic information and also genetically alter the patient’s genome. These viruses are unable to copy themselves but still pose a problem in altering protein synthesis when these retroviruses splice a patient’s cells. This is when retrotransposons come into play. There are parts of DNA from a cell that can copy themselves onto other sites in cell’s genome. The only type of such a transposon is a yeast transposon, called Ty3. This yeast transposon is still under research.
  2. Helium gun: This technique involves bombarding target cells with gold molecules coated with genetically altered genes. This is done with the help of a pressurized gun that is filled with helium.
  3. Liposomes: Liposomes are hollow, fat molecules present in the form of a solution. This method is being researched by the Royal Brompton Hospital in London headed by Natasha Caplen (Glauisisus.1996). She is using liposomes in experimentation with cystic fibrosis. Cystic fibrosis is a disease that is caused by a chloride ion build up in the respiratory tract which causes difficulty in breathing. By inhaling liposomes coated with genetically altered genes prevented the buildup of chloride ion and they recorded a significant decrease in chloride ion levels. Unlike retroviruses, this method does not pose any harmful side effects.


Gene Therapy As Future Of Personalised Healthcare


The first disease that was approved for gene therapy was adenosine deaminase deficiency or ADA. Children who have this deadly disease are seriously prone to most of the minor illnesses. If untreated, it becomes the reason for death too.

The same procedure is under development and under research for AIDS.

Another major issue that attracts gene therapy’s attention is cancer. An experiment was done at the University of California in LA led by Habib Fakhrai, which involved studies on rats with tumors. They had sixteen rats of which eleven of them were treated with 9L gliosarcoma, the genetically altered gene. This treatment blocked the synthesis of a protein called TGF – beta. A molecule responsible for decreasing the immune action. After all was said and done the eleven rats that received the treatment were alive while the others died of cancer.

There are many other diseases that may be cured by gene therapy some of which include Rubinstein-taybi syndrome, partial epilepsy, cataract, prostate cancer , male infertility, Alzheimer’s, schizophrenia, usher syndrome, and maternal acute fatty liver of pregnancy. Genes of these diseases have been identified since 1995.




  1. Untapped Potential

One notable factor that gives gene therapy the edge is the remarkable therapeutic potential it has.


  1. Replacement of Defective Cells

We are constantly attacked by newer, more dangerous and vituperative types of germs and pathogens. Although many of such diseases can be treated or cured medically, there is no cure for genetic disorders unless defective cells are replaced by proper ones which is what gene therapy does.


  1. End of hereditary diseases

With gene therapy, the cells carrying the genetic disorders are altered. So fixing them before they could be passed on could end the line of family members getting the same illness that debilitated their relatives.


  1. Little Risk of Mutation

Unlike many other types of cellular treatments, gene therapy has a very low risk of the genes that are used mutating. This is because they are not necessarily “new” genes, but simply duplicate of genes that we already have within our body.


  1. Imagination comes true:

Gene therapy makes it possible for one to produce a cell, tissue, an organ, of even an organism of their choice.




  1. A  Potential threat due to weaponization:

Genes are the mastermind of our functioning, if altered with bad intentions and modifying organisms to build a greater power, they can pose a serious threat to the society.


  1. Damage In The Gene Pool:

If gene therapy was performed to a certain degree, it possibly could permanently change the human gene pool.


  1. Expensive:

This treatment therapy may possibly be for the rich only, and without the further advancement in technology, could make the rich richer and poor poorer.


  1. Rise in Disorders: 

There’s an exact point in the host genome where the right genes should be brought in and there are no assurance that the viral enzyme responsible for this step will be able to bring in the right genes at the exact point in the host genome. If there’s an error in the process, the results could bring about severe disorders. In addition, the body may destroy the vector perceiving that it is a foreign body.



List of Pros and Cons of Gene Therapy

Drug Reviews: Ibuprofen vs. Aspirin

                                                              What are Aspirin and Ibuprofen? 

Both are common Over The Counter (OTC) drugs, which means they are easily available from a chemist without any medical prescription. However, this makes the patients believe that these drugs are totally safe, which is not true. Therefore, proper knowledge about usage, dosage, side effects and interaction with other drugs is essential. Both belong to the same category known as NSAIDs (Non-steroidal Anti-Inflammatory Drugs). Aspirin apart from this has a reputation for its anti-platelet action.
While technically both the drugs act as painkillers, Ibuprofen is more popular as a painkiller in comparison to aspirin, proving to be effective in cases ranging from mild to severe pains due to arthritis, toothaches, muscular pains and menstrual cramps. Inside the body, ibuprofen blocks the enzymes which send the pain signals to the brain, thus reducing the pain.
Aspirin is one of the oldest known painkillers to man, however, it is more commonly used as an anticoagulant, or in common man’s terms “to thin the blood”. It does this job by inhibiting the ability of blood platelets to clump together, thus preventing the formation of a clot. Someone who has suffered a stroke or heart attack is very likely to find a regular dosage of aspirin in his/her prescription. Aspirin is used as a painkiller for mild cases of headaches, migraine, and fever, but is unsuccessful in curing pains caused by muscle cramps, bloating and skin irritation.
                                                                                   Side effects
Talking about the side effects of these drugs, the two have similarities as well as differences. Both can cause problems in the gastrointestinal tract. It is advisable that these two should not be taken empty stomach. Doctors recommend that at least a light snack should be taken prior to ingesting these medicines. On ignoring the advice the patients should not be surprised if they have a heartburn or an upset stomach.
Rare side effects of ibuprofen include intestinal and stomach ulcers perforated ulcers and bleeding ulcers, all of which may prove to be fatal. Aspirin overdose can also cause excessive stomach bleeding, which may have some serious consequences. Also, if you have a history of high blood pressure, then it is pretty sure that aspirin is going to worsen the problem. Aspirin dosage should be stopped a week prior to any type of surgeries to reduce the risk of excessive bleeding.
Long term effects
Aspirin is commonly prescribed in moderate doses to heart patients on a regular basis as it prevents strokes and heart attacks. Keeping in mind the risk of high blood pressure, this therapy is applied to only those patients who have already suffered a stroke or heart attack. Long term dosage of aspirin has also been proven to have anti-cancer effects on the body.

However, the less ibuprofen you use, the better it is for you. The best way to determine your dosage for ibuprofen is to use it in the least amount possible for the least number of times. Ibuprofen causes strain on the liver and kidney. So patients with a history of liver or renal problems should avoid it, or seek medical advice before using it. Long term intake of ibuprofen may even lead to a development of renal problems. Ibuprofen has also known to contribute towards heart attacks.
                                                                  Combination with other medicines
Aspirin and ibuprofen should not be taken together as ibuprofen renders passive the anti-coagulating action of aspirin.
Aspirin should not be administered along with alcohol intake as it increases the risk of stomach bleeding and should not be used by patients using antidepressants as it may lead to excessive thinning of the blood. While taking medicines for viral infections or influenza (common cold), intake should be absolutely stopped as it may lead to a rare but potentially lethal disease of the liver known as Reye’s Syndrome, which damages the liver and the brain.



Aspirin vs. NSAIDs: Which Is Best?

Primary Healthcare Startups In India

India’s wealthy populations have access to some of the best healthcare in the world, with highly trained doctors and state of the art facilities. But as you move down the economic pyramid, this access disappears rapidly. And in rural areas, healthcare available to the masses has not advanced much in 50 years. This creates a huge opportunity for entrepreneurs who are developing affordable primary healthcare solutions.

Primary healthcare infrastructure in India is mostly concentrated in urban areas. There’s a pressing need to provide the rural population with access to quality and affordable services.

Karma Healthcare is trying to bridge this gap with the help of technology. The company runs clinics in rural areas       of the desert state of Rajasthan. It gives villagers access to specialised doctors through telemedicine as well as face-     to-face follow-up consultations with local or mobile clinics. It uses tablet computers and medical devices which can     transmit real-time data from patients to doctors located elsewhere.

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 Finding affordable primary medical care can be a headache for people in India. SeeDoc is one of the newest                   companies using technology to solve that problem. Based in New Delhi, its mobile app connects pre-screened               doctors and patients through video calls. the startup’s goal is to provide on-demand service. SeeDoc also has                 partnerships with pharmacies, clinics, and labs so users can get prescriptions, follow-up care, or tests if SeeDoc           also has partnerships with pharmacies, clinics, and labs so users can get prescriptions, follow-up care, or tests if           necessary. SeeDoc’s competitors include Lybrate, which is backed by Tiger Global, and iCliniq.


Healthenablr  India Pvt Ltd., a new entrant in the healthcare technology and services sector announced today that     it had recently closed an $800,000 (Rs 5.5 Cr.) seed round. The startup plans on channelling this investment to           further develop its patented Electronic Medical Records(EMR) technology and consolidate sales efforts. Based out     of Mumbai, HealthEnablr was incorporated in September 2015 by Booth School of Business graduates Bamasish         Paul and Avishek Mukherjee. Positioned as a data-driven telehealthcare company, it assists patients in connecting     with healthcare services and practitioners worldwide through its proprietary web and mobile platform.


 Manish Saraf formed Ujjeewan in West Bengal in January 2014,to address primary healthcare woes in rural parts       of the state, where there is hardly any reach of medical facility/ services. A social impact business, Ujjeewan helps       with last-mile medical services and care through telemedicine, fair price generic medicines, basic preventive                 pathological tests, women’s healthcare services, education and monitoring through women’s self-help groups               (SHGs). The centre at Raniganj sometimes gets 350-400 patients in just three hours, and on an average, clears 100     prescriptions a day. Currently, there are two operational centres, and Saraf’s calculations say the bootstrapped             company will have adequate cash flow after just five more centres, with two due to start this April.


MedGenome is a genomics-focused research and diagnostics company, on a mission to improve global health by         accelerating drug discovery research for pharma companies by decoding the genetic information contained in an         individual’s genome.The company says that it’s the only lab in India to provide a HiseQ 4000 NGS (Next                       Generation Sequencing) machine and the first to establish a facility for non-invasive prenatal testing for the                 chromosomal diseases in India.


India is far from Primary Healthcare to everyone, but these startups give us the hope that we are adapting to change and our healthcare services will be better in future.

7 Indian Genetic Sequencing Startups You Can’t Ignore

With the age of personalized medicine at the brink, it only makes sense that Indian genetic sequencing startups mushrooms to chip in on this medical revolution. With that spirit in mind, here’s a list of 7 startups which provide genetic sequencing as a service.
1. Ganit Labs Bio-IT center– An independent not-for-profit research Centre established as a public-private partnership initiative between the Institute of Bioinformatics and Applied Biotechnology and Strand Life Sciences, both in Bangalore, India.
2. Medgenome– MedGenome Inc. is a genomics-based diagnostics and research company delivering the best of health care by decoding the genetic information contained in an individual’s genome. They are the first mover and market leader in genomics-based diagnostics and research from India with global offices in San Francisco and Boston and is considered to be among the pioneers of Indian genetic sequencing startups.
3. Mapmygenome– Mapmygenome is a molecular diagnostics company to make people proactive about their health. They offer personalized health solutions based on genetic tests that help people to get to know about themselves. By combining genetic health profile and health history with genetic counseling, Mapmygenome provides actionable steps for individuals and their physicians towards a healthier life. Mapmygenome is focused on preventive health care through healthy habits.
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4. Xcelris– Considered to be among the most versatile of Indian genetic sequencing startups, They cutting-edge solutions to researchers across fields such as agriculture, human health, animal science, wildlife conservation, bio-energy, microbial and environmental genetics. Xcelris partners with the biotechnology industry, academia, research institutes and individual researchers in India and abroad. They cater to the needs of researchers by their comprehensive service portfolio ranging from Molecular biology kits, Oligosynthesis services, Sanger Sequencing services, Next Generation Sequencing and Bioinformatics analysis.
5. SciGenom– A Genomics R & D Services company, that provides genomic sequencing and bioinformatics services to life sciences and healthcare businesses globally as well as academic and government institutions in India. SciGenom started operations in Jan 2010. It is headquartered in Cochin, India with offices in Chennai & Hyderabad in India and San Francisco in the U.S. SciGenom is an NABL and ISO certified company, with a fully functional state-of-the-art molecular biology laboratory in Cochin and over 100 employees. It also has an R& D lab that is recognized by Department of Scientific & Industrial Research (DSIR), Ministry of Science & Technology, Government of India.
6. Jai Health– They develop and commercialize preventive health, genomic, molecular diagnostic and personalized medicine solutions for India, Asia, the Middle East and Africa. Research and innovation are at the heart of what they do and they build each solution up from the ground tailored specifically for the markets we serve.
7. Xcode Life sciences– With a panel that covers over 300 parameters that screen for several aspects of disease predisposition, skin aging manifestations, nutrition, and fitness, based on personal genomics. The custom-made genomic testing panels have been hand-picked by their researchers using stringent selection criteria, Xcode’s core area of focus is genomics. Their products are offered in India, Australia & South Africa.

With these string of startups offering the basic requirement of genome mapping it’s only a matter of time before the field of personalized medicines booms in the medical sector. Watch out for these companies and brace yourself for the unparalleled efficiency of personalized medicine!

Genes behind your tightening jeans!

With our jeans tightening, many of us at some point have asked this question to ourselves that why does it happen that some people eat more than us and still the pointer of their weighing machine don’t sway as much? The answer lies in there and your very own genes !

Yes! it’s true that the genes play a role in our body metabolism. Metabolism is the process by which your body converts what you eat and drink into energy required to do the work. During this biochemical process, calories in food and beverages are combined with oxygen to yield energy. Obese people who claim to have “slow metabolism” are proven right by some of the scientific discoveries that relate being overweight with reduced metabolic activity.

UntitledDr. Sadaf Farooqui along with researchers at the University of Cambridge has discovered that the gene KSR2 regulates body metabolism. They worked on two groups of people. One group had people who were obese since they were 10 years old and other was the control group. They found that 2% of obese people in the group had a mutation in the KSR2 gene. The percentage sounds less but it does not mean that only 2% of people were obese because of this gene but 98% of people had obesity probably because of other genes that control metabolism and weight. This gene is responsible for other scaffolding proteins of the body which make sure that the hormones like insulin are correctly processed in the body to regulate how cells grow, divide and use energy. The people who have a mutation in KSR2 gene have increased the urge to eat and a slow metabolic rate. They are not able to burn off the fat they consume and that is because they gain weight.


Dr. Farooqui concluded his discovery with reference to a term called epigenetic where environmental factors and lifestyle choices decide the genes being either on or off. Hence, in general, it is assumed that the person’s lifestyle puts a great impact on the health and body metabolism.


If you are fat and overweight then there is a possibility that you might me having a “fat gene”. The story of the fat gene begins with another study done by Professor Chin-Chung Hui, of the University of Toronto,   on the gene called FTO (the fat-gene) and its regulatory protein IRX3. The protein IRX3 regulates body metabolism and energy expenditure. The protein IRX3 interacts with FTO gene and causes obesity. Researchers found that mice deficient in IRX3 protein are 30% slimmer than their counterparts despite having the same amount of food and doing physical activity. These “slim mice” did not gain weight even when fed a high-fat diet. They were better in metabolising glucose and fat.  These IRX3 deficient mice had smaller fat cells and increased levels of brown fat which is helpful in burning up the unhealthy white fat.

Researchers also say that this IRX3 protein also has functioned on the hypothalamus – a portion of the brain known to regulate feeding behavior and energy expenditure. Overall, this “fat gene“has somehow opened the doors for the discovery of an anti-obesity drug which most of us in current generation dream of. According to an article in The Hindu, the gene responsible for obesity in Indians was identified by Dr. Kumarasamy Thangaraj of Hyderabad-based Centre for Cellular and Molecular Biology (CCMB). He found that the gene THSD7A is associated with obesity. THSD7 is a neural N-glycoprotein which promotes the formation of new blood vessels (angiogenesis). Angiogenesis, in turn, modulates obesity, adipose metabolism, and insulin sensitivity. Dr. Thangaraj explained that the gene is present in everyone, but when there is a mutation in the gene then there is a likelihood that person carrying the mutated gene will end up being obese. Obesity is a multigenic condition. Despite being a multigenic condition, people having the mutation can take measures to avoid obesity.

Another skilful work was done by Dr. Joseph Majzoub and his colleagues to explore why most people gain weight too easily while others eat much and do not gain an ounce. They observed that deletion of the MRAP2 gene leads to fat mice who gained more weight due to fat accumulation in the body than their siblings while eating the same amount of food. According to them, MRAP2 is a helper gene which acts on the brain and giving a signal to another gene which is responsible for controlling appetite. So if the helper gene is deleted then the whole signalling would be disturbed and the mice would crave for food. Hence, this is not just because you eat a lot of food, in fact, it is the slow metabolism of the body which is storing more unprocessed fat and making you look fat. As the scientist said, this discovery would definitely change people’s perspective of seeing obese people as those who lack self-control.

So, after referring to these studies we can conclude that there are some genes in our body that either alone or by participating together in signalling pathways control the process of fat metabolism in our body. Too much food intake is not the only reason for people being overweight. These discoveries have paved the path for many therapeutic strategies to target problems like obesity and diabetes. The studies done so far are like pieces of a puzzle. More pieces like these need to be discovered and arranged together to have a breakthrough in the field of health and medicine. The idea of anti-obesity drugs can be a success story in coming years. Many people can feel happy about the fact that it is not always your fault if you are overweight but it is something in your genes. There may be the metabolising gene, the fat gene, the regulatory protein or something else in your genes that are playing their games well and succeeding in storing unprocessed fat in the body. So next time when someone taunts you about being fat you can explain your point outside diet.


                                              REFERENCES  discover-obesity-gene-8902235.html