Will the Era of 'Personalized Medicine' Based Solely on My Genes Open? [Im Ju-hyung's Tech Talk]

Different Drug Side Effects for Each Patient's Genes
Limitations of Traditional Doctor Prescriptions
Precision Medicine Emerges as an Alternative
Providing Customized Medicine Based on Genomic Information Before Prescription
'Sequencer' Technology Analyzing Human DNA is Key
Costs Have Dropped About 100 Times in the Last 20 Years
Expectations for 'Sequencing at Tens of Thousands of Won' Within a Few Years

Researchers preparing samples for genomic screening / Photo by Yonhap News

[Asia Economy Reporter Lim Juhyung] All pharmaceuticals carry some risk of side effects. These range from mild symptoms to severe conditions, and the biggest issue is that side effects vary greatly depending on the individual's physical condition. Therefore, meticulous checks by doctors are necessary, from vaccine administration to ordinary medical prescriptions.

The reason why side effects vary so widely depending on the drug lies in human genetics. It is difficult to predict which genes in our body will cause adverse reactions to specific pharmaceutical substances. But what if doctors could obtain the complete genetic information of every patient before prescribing medication? There is a possibility that 'customized medicine,' perfectly optimized for the patient's body and free from side effect concerns, could be developed.

◆Different DNA for Each Person... Also Affects Drug Efficacy

The influence of genetics on drug efficacy is very diverse, and sometimes drugs do not work at all depending on the patient's physical characteristics. According to a report jointly released on the 29th of last month (local time) by the British Pharmacological Society and Medical Association, only 30-50% of patients prescribed drugs by the UK's National Health Service (NHS) experience the full intended effect.

Genes can also affect the efficacy of medications taken by humans. / Photo by Yonhap News

Moreover, as many as 99% of people carry at least one genetic variant that affects commonly prescribed drugs such as painkillers, heart medications, and antidepressants. These drugs are routinely prescribed. If they cause even a single fatal side effect, it could pose a life-threatening risk to the patient.

Humans possess diverse genes depending on race, gender, and physical traits. Especially in multicultural and multiethnic countries like the United States and the United Kingdom, it is even more complex as the characteristics of patients from various countries must be considered. Although doctors can access patients' medical information before prescribing drugs, relying solely on documented information has limitations in making perfect judgments.

◆Analyzing DNA in Advance with Sequencers to Provide 'Customized Medicine'

What if doctors could know a patient's genomic information before prescribing medication? They could avoid prescribing drugs that might cause side effects and adjust drug dosages for safer prescriptions.

The medical field calls the optimized diagnosis and treatment method tailored to each patient's physical characteristics 'Precision Medicine.' It means administering only the drugs that perfectly fit the patient's body, like a finely tuned precision machine.

The most essential prerequisite for enabling precision medicine is genomic analysis. Doctors need to know the patient's genetic information in advance to prescribe appropriate pharmaceuticals accordingly.

Genome analysis can be conducted using a specialized device called a 'DNA sequencer.' The photo shows the world's largest DNA sequencer manufacturer, the US company 'Illumina' sequencer (above), and the portable DNA sequencer from the UK company 'Oxford Nanopore' / Photo by Illumina, Oxford Nanopore website capture

Currently, the field where precision medicine is most active is cancer patient care. Generally, anticancer drugs are known to carry a high risk of severe side effects depending on the patient. Therefore, accurately prescribing drugs tailored to the patient's body is crucial to saving lives.

The problem has been cost. Genomic analysis is performed using equipment called a 'DNA sequencer,' which has so far been produced by a few companies such as the US-based Illumina and China's BGI. Sequencers are very expensive, so only large hospitals or global pharmaceutical research labs could afford them, making it difficult for patients to access these services. It is said that former Apple CEO Steve Jobs, who suffered from rare pancreatic cancer, spent over 100 million Korean won on genomic analysis testing in 2012.

◆Sequencing Costs Dropped 100-Fold Over 20 Years

However, recently, some in the medical community have cautiously raised hopes that genomic analysis could become possible for all humanity.

The optimism stems from the dramatic price drop in sequencers over the past few years. Over the last decade, the sequencer industry has seen the emergence of new technology called 'Next-Generation Sequencing (NGS),' which has led to smaller, faster, and cheaper devices. Additionally, the market once monopolized by a few companies like Illumina has seen various startups such as 'Oxford Nanopore' and 'PacBio' enter the field, thanks to NGS advancements.

Over the past 20 years, the cost of genome analysis per test has dropped nearly 100-fold. Photo by National Human Genome Research Institute report capture

According to the 'Sequencing Cost Report' published last year by the US National Human Genome Research Institute, the cost of one DNA analysis dropped nearly 100-fold from $100,000 (about 120 million Korean won) in 2001 to around $1,000 (about 1.21 million Korean won) in 2021.

The COVID-19 pandemic, which has disrupted daily life worldwide for nearly two years since 2020, also contributed to the popularization of sequencers. Governments and research institutes worldwide have actively purchased small sequencers to analyze the genomic variants of the coronavirus.

◆Optimism for Blood and Saliva Tests Costing Around 200,000 Won Within Next Year

If sequencer technology continues to advance rapidly, it is expected that genomic analysis costs could drop to tens of thousands of Korean won within a year.

Dr. Munir Pirmohamed of the British Pharmacological Society argued that national health authorities should mandate genomic testing for all citizens. He emphasized, "We are entering a new era of medicine. By administering the right drug, in the right amount, at the right time to patients, we can enhance effectiveness, treat symptoms and diseases, and prevent side effects."

Professor Mark Caulfield, also of the same society, predicted, "By next year, we hope to offer blood or saliva tests for about 100 to 150 pounds (160,000 to 240,000 Korean won). Predicting drug responses can greatly aid treatment."