In Precision Medicine, So Much Progress, So Far to Go

I have had the privilege of watching medicine change in ways that, not long ago, would have seemed almost unimaginable. Few changes have been more profound than the rise of precision medicine. In oncology, our ability to understand the biology of an individual’s cancer and then use that information to select a treatment has fundamentally changed what is possible.

There was a time when we largely treated cancer according to its site of origin. Today, we increasingly recognize that 2 tumors arising in the same organ can be driven by entirely different molecular abnormalities, and they may respond very differently to treatment. Two cancers originating in different organs may have similar genomic drivers and could be treated with the same targeted therapy.

That realization has changed everything.

The ability to identify molecular targets and develop therapies against them has given physicians new tools and, more importantly, has given patients new possibilities. I have seen firsthand how precision therapies can give patients years of additional life. But longevity is only part of the story. What matters with equal measure is how people live those additional years. Precision therapies can sometimes control disease while allowing patients to continue working, spend time with their families, travel, pursue their passions, and simply live their lives.

This is why precision medicine has become more than a professional interest for me. It has become a major focus of my career. Recently, I was honored to be appointed medical director of precision medicine for The US Oncology Network. I see this opportunity not simply as a new title but also as a responsibility to help bring the promise of precision medicine to physicians and patients across a large national oncology network.

Working in community oncology has reinforced for me that innovation only matters if it reaches the patient sitting in front of us. We cannot build a future in which the latest advances are available primarily at major academic centers while patients in community and rural practices are left behind. Precision medicine must become part of everyday oncology practice, not an exception reserved for a select few. And this transformation extends far beyond oncology. Precision medicine is reshaping cardiology, neurology, rare diseases, immunology, infectious diseases, and many other areas of medicine. We are moving toward a health care system that is increasingly informed by the unique characteristics of each patient rather than relying exclusively on a one-size-fits-all approach.

But there is a troubling disconnect between what medicine can do and what patients can access.

A scientific breakthrough means little to a patient who cannot afford the molecular test needed to identify a treatment. It means little if insurance coverage creates unnecessary delays. It means little to someone living far from a cancer center who cannot easily access the expertise required to interpret increasingly complex genomic information.

We have become remarkably good at finding the target and hitting those targets. Now we must become just as determined to make those discoveries accessible.

That means lowering the cost of testing and treatment, expanding access to genomic medicine in community and rural settings, removing unnecessary barriers, and ensuring that patients can receive appropriate testing and therapies regardless of their financial circumstances or where they live.
I am enormously optimistic about where medicine is going. But optimism comes with responsibility. The promise of precision medicine should not belong only to those who can afford it or live near the institutions pioneering it.
We have already changed the science of medicine. Now we need to change the system around it.

The future is increasingly precise, personalized, and powerful. Our job is
to make sure it is also affordable, accessible, and available to everyone who needs it.