Molecular Imaging Insight - September 2007 - (Page 13) Full transcript of SNM roundtable ADDITIONAL RESOURCES: PERSONALIZED MEDICINE Q Can you describe personalized medicine? MANUEL CERQUIERA, MD: As a clinician who both sees patients and performs diagnostic studies, to me personalized medicine is trying to make the right diagnosis on the patient and then using that information with imaging or other techniques to make decisions about therapy. It also means selecting a therapy which is appropriate for the patient—not something that’s based on 1,000 patients—but something that’s unique, that’s going to be the right treatment without undue side effects and get the best cure. What kinds of things matter to a patient? Obviously, mortality, whether they’ll live or die; morbidity, whether they’ll have more complications or not; symptom control, the quality of their life; and finally, cost. Consumers are becoming much more involved in having to share healthcare costs, so they do look at what new technologies cost. Q Q In what areas are personalized medicine accelerating, and what are the challenges? TIM TRYSLA: Clinical medicine as it has been practiced for thousands of years necessarily always has been personalized medicine. And the major advance that we have nowadays is that we are increasingly developing tools to determine the individual situation of the patient. On the one hand with regard to his or her psychological status, and on the other hand to the status of his or her disease. I think imaging is of course a very good example for this. The challenge in clinical medicine is always to bring together the soul and the body and how they interact. There are areas of research that look into that matter more deeply, and also look at imaging and how the individual brain functions. Of course a doctor caring for his patients would always—and this has also been stated by medieval physicians—talk to his patients, and this is the challenge of technological medicine that although we have new technology at hand which is very powerful, we should still keep the close contact with the patient. Are you supportive of identifying groups who may be more responsive to a particular treatment? What about the cost? And what about those who don’t respond? TRYSLA: Those are incredibly important questions, but I think something we haven’t talked about is value. Personalized medicine is the cross reference of science, education and a voice of the patient. Once that education is done, and there are clinical pathways that are universally accepted by the “Clinical medicine as it has been practiced for thousands of years necessarily always has been personalized medicine. And the major advance that we have nowadays is that we are increasingly developing tools to determine the individual situation of the patient.” Tim Trysla, counsel of the healthcare group at Alston and Berg and executive director of the Access to Medicare Imaging Coalition Q What does all this mean to the patient? RON PETROCELLI, MD: It means that the patient has to become more involved in the decision-making and partnering with his or her physicians. It’s incumbent on the average patient to learn more about what’s going on in the healthcare field. It means for the patient that when he or she selects a physician and the site of healthcare that he or she needs to know that the places are using up-to-date technology, but also bearing in mind that the individual patient has to be involved in the decision-making and discussing with the physician. Otherwise, decisions will be made for the patient instead of with the patient, and I think ultimately that would not be in his or her best interest. medical profession, there’s a role for government to increase the use of those and utilize those kinds of tools, But the No. 1 cost driver still remains the physician’s need to show value and how she practices medicine. So getting that information both in the hands of the patient as well as the physician to do the right thing the first time is critically important. But it’s going to be incumbent upon manufacturers, clinicians and researchers to really show value for that incremental increase in health. It won’t get paid for unless you’re bringing the value equation to payors, as well as government. MOLECULAR IMAGING TECHNOLOGIES Q Q What particular challenges must be overcome as these types of personalized treatments become available? DOUGLAS HADLEY, MD: As new technologies such as molecular imaging come out, it’s incumbent upon members of the insurance community that pay for them to examine the evidence, to take a look at how effective they are. That’s what our group [Cigna] does. And the kind of evidence that we think are the most important to look at are what we call “poem”—patient-oriented evidence that matters. What do molecular imaging technologies bring to the table for diseases such as cancer and coronary artery disease? TORSTEN KUWERT, MD: This question sounds quite simple, but this answer could take several hours. With the advances in molecular biology, increasingly we think that diseases originate in disturbances of molecular processes and that these disturbances are earlier than disturbances in the structure of the human body. Having the means to image these molecular processes allows for an earlier diagnosis of disease [is needed] in many cases. In many other cases, more specific diagnosis of a disease since alterations in structure may signify a different disease process, and by looking more specifically at the molecular pathogenesis, we get an earlier diagnosis. MolecularImaging.net Molecular Imaging Insight 13 http://molecularimaging.net/index.php?option=com_content&Itemid=2&task=view&id=8 http://MolecularImaging.net
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