The era of precision medicine is the future of health service. Through precision health service, disease etiology, risks, diagnosis and therapy can be better handled.
By
DEONISIA ARLINTA, AHMAD ARIF, WILLY MEDI CHRISTIAN NABABAN, HIDAYAT SALAM
·6 minutes read
KOMPAS/RIZA FATHONI
Yarsi University Medical Faculty staff, Cempaka Putih, Jakarta is currently examining a patient's genetic sample in the laboratory, Friday (13/1/2023). In precision medicine, it is possible for a person to get more sensitive health screening, precise diagnosis, and effective therapy.
JAKARTA, KOMPAS — The health service keeps developing along with technological progress. Health service with greater precision suited to individual needs is increasingly made possible. This contributes to the quality enhancement of intervention in terms of prevention, diagnosis and therapy in society.
Dean of the Medical Faculty, University of Indonesia (FKUI), Ari Fahrial Syam, said the health service was entering the era of precision medicine. It means that service will be provided with precision for every individual according to relevant characteristics such as genetic, clinical, environmental and lifestyle manifestations. This service is even more enabled in the era of industrial technology 4.0 that relies a lot more on artificial intelligence (AI), big data and the internet of things.
“Through precision medicine, intervention in patients becomes more accurately targeted. The service provided can be more effective and efficient,” said Ari in Jakarta on Sunday (15/1/2023).
Ari indicated that basically every human was endowed with a unique DNA sequence. This explains why every individual has an exclusive vulnerability to disease and response to therapy.
Ari’s research presented at his installation as professor of FKUI in 2018 gave evidence that ethnic and cultural diversity in Indonesia has an influence on Helicobacter pylori (H pylori) infection that causes a stomach disease.
Based on his finding, patients from Papuan Buginese and Batak ethnic groups have high activity of H pylori. However, patients from other ethnicities show resistance to antibiotics. For example, Ambonese, Chinese, Balinese and Javanese ethnic groups are resistant to clarithromycin while the ethnic groups in Sumatra are resistant to metronidazole.
Every human was endowed with a unique DNA sequence.
The information strengthens the understanding of the importance of precision medicine. Genetic variations and different clinical manifestations as well as different responses to drugs affirm the presence of different individual reactions to a certain disease. “So, the method of diagnosis and the administration of drugs are slightly different,” he pointed out.
The initiation of precision medicine was also developed in the handling of diabetes mellitus. In 2018, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) began to identify precision health in the diagnosis, therapy, prevention and prediction of diabetes mellitus.
ZULIAN FATHA NURIZAL
A young man performs early detection of peripheral neuropathy at the commemoration of World Diabetes Day 2022 in Jakarta on Wednesday (9/11/2022).
This initiation was expected to explain the etiological diversity of diabetes through the identification of risk factors, biomarkers, genomics, pharmacology and lifestyles.
Research conducted by FKUI professor Dante Saksono Harbuwono, now Deputy Health Minister, revealed that precision medicine enabled more specific diabetes mellitus therapy based on individual characteristics. From his study, only 30 percent of diabetes patients in Indonesia had their blood sugar under control after consuming drugs. This is due to different individual responses to certain medicines.
Through precision medicine, drug selection can be more accurate based on individual conditions. The disease will thus be better controlled so that complications can be prevented and health maintenance costs reduced.
Dean of the Medical Faculty, Yarsi University, Rika Yuliwulandari, added that the types of drugs needed by every individual could be different, depending on relevant genetic information. Some drugs can be effective for certain persons but others may not be effective, even triggering side effects if consumed.
The one-size-fits-all approach is no longer relevant today. The administration of drugs needs to be adjusted to individual genetic information for the sake of increasing the effectiveness of pharmacological treatment.
“There are two approaches, preemptive and postemptive. So, genetic examination can be done before therapy and after it, such as when the drugs administered produce no impact. Both are important for prevention, although the preemptive step is the best,” she said.
Ari said precision medicine could be applied to individual service and public health service. From individual data, precision medicine assists people in making adjustments to suitable behaviors and lifestyles. The data can later be developed to cover a broader social level.
DOKUMEN RSPAD
Activities of health workers in the Cell Cure Center laboratory at Gatot Subroto Army Central Hospital, Jakarta, some time ago.
Development
Precision medicine research and development have begun to be carried out in several countries such as Taiwan with its Taiwan Precision Medicine Initiative, Singapore with Precision Health Research in Singapore and the UK Biobank in the United Kingdom. The initiatives have the same goal, which is the quality promotion of health service in society, like the nursing plan, the management of genetic disorders and the identification of new biomarkers for drug development.
A molecular biology researcher from Indonesia at John Curtin School of Medical Research, Australian National University, Ines Atmosukarto, also the CEO of Lipotek Australia, said precision medicine had potential for development in Indonesia. With a 270-million population of diverse ethnic and cultural backgrounds, its genetic variations can be heterogeneous.
So far, the genomic information available has mostly come from Western countries. In fact, genetic differences affect the analysis of sources of diseases. The development of drugs also mostly refers to population tests in the West. Consequently, there has been less optimum disease handling, such as the treatment of tuberculosis.
“Indonesia should get prepared for the development of precision medicine. With its science and technology already geared up and accessible at present, precision medicine development should not be something impossible,” assured Ines, now also an expert staff member of the Health Ministry.
Several things need to be readied in precision medicine development in Indonesia. They cover infrastructure, including laboratories and genomic examination devices, regulations, clinical testing capacity, human resources and public understanding of precision health. “Data processing capability is an important aspect in the application of precision medicine in the interest of public health,” said Ines.
A geneticist specializing in nutrigenomics from the Mochtar Riady Institute for Nanotechnology, Safarina G Malik, said the diverse and unique population of Indonesia required the processing of very big data before mapping its health characteristics and disease vulnerabilities.
Data processing capability is an important aspect in the application of precision medicine in the interest of public health.
Most health services currently promoting precision therapy are not yet based on the typical genetic characteristics of Indonesians, but rather on genetic study references in other countries. These are not definitely suited to the conditions of Indonesian people.
For this reason, according to Ines, the Health Ministry’s commencement through the Biomedical & Genome Science Initiative (BGSi) is appropriate. Then initiation is to produce genomic references of Indonesians based on the genomic data of the Indonesian population.
These data can identify variants of diseases in society. “Communities, donor institutes, start-ups, pharmacies, colleges and health service providers should be involved in the development of precision health service in Indonesia,” added Ines.
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