Despite precision medicine being touted as the future of healthcare, many Americans are still not familiar with it. This is unfortunate as precision medicine can help identify which therapies will be most effective for individual patients based on their genetic, environmental and lifestyle factors.
Yet, cost and access remain two primary barriers to its adoption, as not all insurance plans cover these services and genetic testing is often done in academic settings or urban centers.
However, the COVID-19 pandemic has forced telehealth into the mainstream and it might just be the push we needed to bring the benefits of precision medicine to more patients.
Reports show that the U.S. telehealth market is experiencing rapid growth, with one report showing an 80% year-over-year increase this year due to the pandemic. Many health systems have experienced even more explosive growth rates.
As a result of the influx, many clinics and hospitals have had to build or expand their telehealth offerings in a matter of weeks. Now, only months later, more practitioners and patients have been pushed out of their comfort zones to use this modality. CMS has helped hospitals rapidly adapt, thanks to new regulatory flexibilities, and some insurance companies have aligned telehealth costs with the cost of in-person visits. These are encouraging steps forward and with this change in attitude and renewed confidence in telehealth, we’re hopeful precision medicine can become more widespread. It certainly fits.
By nature, precision medicine is well-suited to occur outside of the clinic or hospital setting. For example, precision medicine centers around conversations with patients and counseling them about potential genetic risks for certain diseases and possible prevention protocols or treatments. My work at the Brotman Baty Institute for Precision Medicine in Seattle is guided by the principle that if we know a patient’s genetic background, lifestyle and family history, we are better positioned to prevent disease from developing—diseases that the patient may be pre-disposed to and are at increased risk for. We can do at-home saliva samples to test for more than 300 genetic risks for diseases like cancer or heart disease. We can counsel patients over video conferencing and communicate results via secure online portals.
A recent patient story comes to mind that happened not long ago during COVID-19. This patient had dilated cardiomyopathy, a disease of the heart muscle. He was referred to me for genetic evaluation by telemedicine. He tested positive for the TTR gene, which can lead to stiffening of the heart walls and other serious complications. Since I was able to test him with an at-home genetic test, we were able to identify this risk factor and his cardiologist was able to get him on Tafamidis, a recently approved treatment for people with TTR-related amyloid cardiomyopathy.
This man’s treatment journey was particularly important for him as well as his family. Since his condition is genetic, and dominantly inherited, it would be expected that five of his 10 siblings will test positive for the same TTR variant with increased risk to develop cardiomyopathy. Siblings who test positive can receive early intervention and treatment. Siblings who test negative are not at risk to develop the cardiomyopathy this gentleman has. This illustrates the power and potential of precision medicine to help many people in a family from the result of diagnosing a single patient.
If the hope of precision medicine is that it should be accessible to all, then we need to be able to access these technologies not just now, but in the future. It’s important that we continue the expanded use of telehealth long after the COVID-19 pandemic is over.