Andalusia and Catalonia lead, at this moment at least, the Momentum of personalized medicine in Spain, according to the study Precision personalized medicine in Spain: map of communities, which was presented this morning and which is based on the consultation of regional plans and surveys of specialists (researchers and representatives of the Administration). The other three communities that have a "high development" of initiatives in this sense are Castilla-León, Galicia and País Vasco. By order in this sort of classification, the following are Balearic Islands, Extremadura, Madrid, Navarra, Murcia, Valencian Community with a "medium development". They close the list, with a "low development", Asturias, Aragon, Canary Islands, Cantabria, Castilla-La Mancha and La Rioja.
Precision and personalized medicine is a broad concept that refers to the diagnosis and selection of treatments through genetics and other data, explained Guillermo Antiñolo, scientific director of the Medical Genome Project and one of the participants in the work. But it is not something from the future, but it is already here, he added. Somehow, when a woman is diagnosed with a Breast cancer HER2 + (which has many copies of that gene) is already practiced, for example, and that has been done for a decade. New developments such as the determination of genes involved in rare diseases or the use of Big Data to adjust a treatment are other variants of this approach.
To elaborate the map – of which Manel Carrasco, director of the Ascendo health consultancy and author of the report warns that it is a fixed photo that can change quickly – aspects such as the inclusion of specific plans to implant or develop this type of therapies have been studied, the assignment of referral centers for this, if there are projects to accelerate their use in clinical practice after the corresponding investigation, if there are any to include the data at the genomic level in the electronic medical record, if specific training is offered in this respect and if public-private partnerships are established to develop it, among other parameters.
Of these, Antiñolo has highlighted the importance of sharing information. "Like Soledad Cabezón MEP, I talk about data that heal." In that sense, the fact that genomic and other information omics (proteins, epigenetic markers) is in the digital medical record is fundamental, he said. "You have to work on a minimum set of basic data to share in real time" among all the communities. But, precisely if something makes this map relevant, it is that "fragmentation is common, and that is the worst enemy" for the development of a system, he said. Another aspect highlighted by Antiñolo is that in Spain there is no specialty of Clinical Genetics, with which obtaining all this information is in the hands of professionals who are not specially trained in the field.
As usual, since establishing the vaccination calendar to develop palliative care laws, the communities have already moved ahead of the plan that the Ministry of Health started working on, and now it is not known how it will be. The Senate concluded last January in a paper on genomics that this state coordination was necessary to ensure equity and because new personalized therapies, such as CAR-T that consist of modifying the lymphocytes of people with some hematological cancers to attack the cells tumoral, are very expensive: up to 400,000 euros per person.
In this regard, Albert Barberà, general director of Research and Innovation in Health of Catalonia, has pointed out that the cost-effectiveness balance must be taken into account. "Although it is a thorny issue," because it involves putting a price on a treatment, "we must take into account the health economy." With a new criterion, according to Barberá: to ask if it has improved the quality of life of the patients.