The great global genetics plan is already being tested in Extremadura


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The Medea projectbegan in Extremadura in 2013, and aims to reach the entire population and for life treatment optimizations that the patient can receive, adapting to their genetic profile the drug prescription. Including this information in the clinical history so that both the patient and the healthcare provider can have access to it and thus improve the therapy.How many times has it happened that a drug works for some and not for others, this may in part have to do with the genetics of each person. Better attention to these details helps to see the whole picture that allows a better doctor-patient relationship.

Adrian Llerena, responsible for Medea, remembers the beginning of the project perfectly. «It was the day that Pope Francis carried the Vatican and us the cross of Medea. We went to look for funds in a different place, which Health does not usually go to, which was the industrial innovation site. Especially when we have a health system that has the inertia to provide services, but innovation does not. put in value. Still it worked. Medea is the only initiative of this sense worldwide that is taking place.

The project has been developed in the Badajoz Health Area Clinical Research Center (CICAB), where the Pharmacogenetics and Personalized Medicine Unit that leads the project, initially regional in scope, has been created. The chosen place was Estremadura because it is a small population that it only has one health system and without great differences or social inequities. The population is fed in a similar way and they have a single electronic medical record system that covers both primary and specialized. And to this is added a strong sense of belonging to the community.

Dynamic vision

The project took off on June 1 and 474 patients have been studied and there are 85 researchers involved in 33 centers, to zero cost, including from small health centers to the liver transplant system. It tries to cover not only the superspecialization, but also the family centers in the more remote places. And the toilets are not charging, but rather, as Llarena indicates, “they are using altruism” to carry it out. The patients have been chosen starting with the most needy: oncology and people with severe mental disorders. A team of a psychiatrist, a pharmacist and three nurses have traveled to the psychosocial rehabilitation centers. The target is the entire population, but prioritizing patients in what this will be most useful.

For Llerena it is a ‘glocal’ project, that is, it begins in a place where you control the characteristics well, with high community empowerment to think about humanity. It is about reconceptualizing the genetic biomarker in the context of the evolution of the patient. The Medea coordinator confesses that this is difficult to understand because it is thought in a static way and compartmentalized by specialties, instead of see the patient as a whole. When a subject is medicated, this interacts with the other medications he is taking or has taken, his lifestyle, as well as his diet, among other variables unique to that patient. And these cDeterminants vary throughout a lifetime.

“The population must understand that a drug is the last resort and has a price or risk of adverse reactions that are the sixth leading cause of death,” says Llerena

The first phase of the project involves gathering information from 3,000 patients, then a competition for ecompanies of Artificial Intelligence and genetics to develop the systems that will make it possible for this information to be in a database shared by the health system. And the next step is program evaluation that has been developed. It is a co-innovation between the public-private system. The great barrier has been to change the mentality, putting in value the knowledge that this work generates. The obstacle at the level of healthcare professionals is using genetics in a way that was not in their curricula.

For Llerena, “the population must understand that a drug is the last resort and has a price or risk of adverse reactions that are the sixth leading cause of death.” Projects like Medea lay the foundations for precision and preventive medicine. “Avoiding something that people did not initially incorporate as a problem is not easy. Just like we have a car and we have a road safety plan … why don’t we have it with the medicines?»Llarena wonders. It is also about betting on a medicine based on prevention and self-care and not only on diagnosis and treatment.

The person in charge of the Medea project also raises the need to quantum software for pharmacogenetics, since ordinary computers will not do manage or store the huge amount of information that having the genetic profile supposes of an entire population. In fact, it is a different project in which he also collaborates.

All these projects acquire a special importance in Spain for being one of the countries with the largest number of elderly people. When you have an aging population where the use of drugs increases, Llerena affects the importance of genomics, in general, and genetic tests, in particular. Tomorrow everyone will have their genetic card. And the first stone to build that future has already been laid in Extremadura.

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