Everyone is talking about Asia’s booming economy and meteoric rise on the global stage. In parallel, precision medicine is the hype du jour. But precision medicine in Asia? Should you be setting your sights on this region? The resounding answer: Yes, but let’s explore.
Precision medicine is often exclusively associated with genomics. While an important component, genomics is but a small piece of precision medicine. In fact, the National Institutes of Health (NIH) in the U.S. has defined precision medicine as an “emerging approach for disease treatment that takes into account individual variability in genes, environment, and lifestyle for each person.” But as of now, with all the disciplines making up precision medicine, genomics is currently the most studied and best understood so far. And with highly robust tools and reproducible processes it is not surprising to see genomics as the key focus today.
Much of precision medicine discussions today center around consumer genomics (direct-to-consumer genomic services), which itself is undergoing a transformation as business models, sequencing technologies, and data management strategies evolve. If we are talking about consumers, it is inevitable to discuss the largest consumer base in the world – Asia. Two out of every three people on this planet live in Asia, yet genomics efforts have hardly kept up with this demographic reality. In fact, Asian genomic data is scarce, representing only 15% of genomic data.
So, what is the issue if there is a lack of Asian genomic data? With 99.9% of the human genome identical, is it really that important? The clear answer: Yes, it matters. There are several use cases where the 0.1% makes solutions futile or even fatal.
- Pharmacogenetics: Pharmacogenetics is the field of study relating to genetic differences and the impact on drug responses. Take warfarin, for example, a well-known blood anticoagulant. The same dose given to an individual of European ancestry has potentially life-threatening consequences for a large subset of East Asians, South Asians, and Southeast Asians. Developing medical solutions without appreciating the importance of underlying genetic variation may not only mean your drug is ineffective for two-thirds of the world's population, but also risks the lives of those it is prescribed to.
- Not all diseases are created equal: Different populations may manifest the same disease very differently. A well-known example is that of "lean diabetics." The average Asian diabetic is lean compared to his or her European or North American counterpart. The Asian diabetic also presents different risks. In Singapore, a study done on 60,000 ethnic Chinese found diabetics to present a threefold increased risk of mortality from liver disease compared to a non-diabetic obese individual. This single use case suggests how a different approach in addressing the same disease is crucial.
If you are a drug developer, or your company is developing a connected device that inputs health parameters and creates health alerts for a healthcare provider, you need to keep this in mind. If your drugs doses or algorithms were designed based on physiological parameters of individuals from European ancestry, you could well be missing out on an accurate diagnosis – and the market opportunity – represented by 70% of the world’s population. Several governments, corporations, and start-ups are currently ramping up efforts to fill this gap via national-level initiatives, joint ventures in the local ecosystem, public-private partnerships, and direct-to-consumer solutions.
As mentioned earlier, while genomics is the current focus, it is but a small part of precision medicine. Several other aspects such as behavioral, nutrition, and lifestyle factors play a critical part in determining the efficacy of a health intervention. That only opens up another major opportunity as Asia’s wide range of cultures also comes with an equally diverse diet, lifestyle, and cultural norms that have bearings on their health. Precision medicine is only one of the areas in the fast-rising health and wellness personalization space – it would be unfortunate to miss out on the majority of the addressable market due to a simple lack of data. Those vested in precision medicine and broader personalization should view the lack of Asian genomic data as an urgent issue to address, as it is equal parts opportunity and risk.