Precision Medicine: A Wider Definition (2015)

To the Editor: The U.S. administration has just unveiled details about the Precision Medicine Initiative, an ambitious new research effort to revolutionize approaches to improve health and treat disease.1 This initiative will pioneer a new model of a patient-powered research agenda targeted to accelerate biomedical discoveries and to provide clinicians with new tools, knowledge, and therapies to customize care for individuals. It has been launched with $215 million of funding. The precision medicine model promises that the fundamentals of health care, including assessments, medical decisions, and treatments, will be customized to the individual. In this model, diagnostic testing is preferentially designed to select optimal therapies based on an individual's genetic makeup, other molecular or cellular analysis, or imaging, but these tools do not provide clinicians with individualized objective phenotypic data on function and overall health status. This critically important element, which should guide the strategies used to support the well-being and quality of life of younger and older people alike, can be missing when applying precision approaches. Once elusive, objective phenotypic data on function and overall health status are increasingly available because of valuable partnerships between biomedical engineers and clinicians. Rapid advances in development of “precision” wearable technologies and mobile health allow objective tracking of health status and response to interventions, including mobility, posture, daily activity, and sleep quality—all important aspects of function related to healthy aging. Consumers supporting self-care have widely adopted wearable technology, which is being increasing used in health care. For example, biometric body-worn sensors can provide comprehensive physiological data that is analyzed in real time using increasingly sophisticated signal processing algorithms yielding “precise” understanding of complex physiological data; informing individualized diagnostic, management, and rehabilitative strategies; and contributing to risk stratification, treatment decision-making, and outcomes assessment. These technologically advanced sensors, instruments, and software, having long been used in biomedical and engineering research, physical therapy, occupational therapy, orthopedics, neurological rehabilitation, sports medicine, and medical evaluations, are being increasingly used in the area of aging, characterizing geriatric syndromes such as fall risk and incidence, frailty syndrome, and outcomes in aging-related conditions, including stroke, Parkinson's disease, cognitive impairment, and beyond. The potential for precision medicine to improve health care and speed the development of new treatments has only just begun to be realized. The Precision Medicine Initiative must not be artificially limited in its reach and should be expanded to include biomedical advances that improve quality of life. Body-worn-sensor precision medicine has already led to powerful new findings that are informing the development of customized interventions that are highly relevant to older adults with geriatric syndromes and multimorbidity. Broadly collaborative precision medicine efforts can be instrumental in accelerating discoveries in this emerging field and provide much-needed objective data to inform function-based health outcomes. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: All authors played a role in preparation of this letter. Sponsor's Role: N/A.