Our health care system is outdated, which makes it weak. Figure 1 shows some of its most challenging weaknesses, which we can now eliminate by rejecting traditional one-size-fits-all medicine and replacing it with precision medicine, a modern customized approach. Precision medicine provides a new, more robust health care ecosystem based on the latest technologies and innovations, highlighting the urgent need for reform in our health care system.
Fortuitously, GenAI, genomics, precision medicine and computer-driven big data analysis/systems are all experiencing simultaneous growth and advancement. With this integration of innovations and novel technologies, audiologists, as key health care professionals in hearing health care, are not just bystanders but integral players who can adopt a range of new, improved and competitive options, thereby contributing significantly to the advancement of health care.
These three emerging innovative technologies—GenAI, big data analysis and genomics—are interacting and maturing simultaneously to give life and significance to precision medicine. President Obama launched the Precision Medicine Initiative in 2015 with a proposed $215 million investment to revolutionize health care and medical treatments, including establishing a voluntary research cohort of at least one million Americans from whom to collect genetic data, biological samples and health information to create a large database for research to revolutionize health care and medical treatments (Obama White House, 2015).
The initiative emphasizes public-private partnerships, engaging academic medical centers, researchers, patient groups and the private sector to develop the necessary infrastructure and approaches for precision medicine. Precision medicine is not just a passing trend but a transformative force that is here to stay. It will provide the organizing ecosystem for 21st-century health care, inspiring us all with its potential to revolutionize our field.
PRECISION MEDICINE
Precision medicine considers individual variability in genes, environment and lifestyle for each person and targets the right treatments to the appropriate patients at the right time. It encompasses emerging approaches to disease diagnosis, prevention and treatment based on individual variations in genetics, environment and experiences (Rudman et al., 2018).
Precision medicine uses large datasets, including lifestyle, medical and genomic information, to make health care more personalized and effective. This approach allows doctors and researchers to predict more accurately which treatment and prevention strategies for a particular disease will work in which groups of people. It contrasts with a one-size-fits-all approach, in which disease treatment and prevention strategies are developed for the average person, with less consideration for individual differences (Cerrato, P., & Halamka, J., (2018); (Cerrato, P., & Halamka, J., (2023).
GenAI, powerful computers, the routine collection and sharing of e-medical records, big data analysis and genomics have empowered precision medicine and made it practical. Here is how:
Generative AI and Powerful Computers: Generative AI’s (GenAI) ability to absorb and rapidly analyze massive datasets that are too complex for human cognition has turbocharged precision medicine and genomics—both benefit when their datasets increase.
Big Data & Its Analysis: Massive data from diverse sources such as electronic medical records, wearables, genomics, lifestyle records and research exceed humans’ ability to analyze them. But GenAI and powerful computers enable big data analysis, allowing us to retrieve, analyze and apply the interrelated wisdom of these diverse datasets.
Advances in Genomics: These advances are central to precision medicine and allow us to personalize disease prediction, prevention, cures and treatment. GenAI, powerful computers and big data systems have combined with genomics to enhance the quality of life and unleash the life-preserving magic of precision medicine. We devote the next article in our Fuel Your Future series entirely to genomics.
HOW DOES PRECISION MEDICINE WORK?
Although precision medicine is a new concept for some, it is a familiar one to audiologists. Personalizing hearing treatments has been a fundamental aspect of audiology since its inception. For instance, when we perform a hearing aid’s first fit, we tailor it to the patient’s audiogram. Similarly, when we incorporate real-ear adjustments, we adapt the treatment to the individual patient’s external ear canal. Precision medicine, informed by massive informational datasets, enabled by AI and driven by fast, powerful analysis, takes this customization to more extreme limits.
The goal is to provide personalized patient care. As illustrated on the following page, precision medicinegathers extensive data, including information about an individual’s health, lifestyle and environment and a vast global knowledge base about disease mechanisms. It then analyzes these data, identifying patterns and using them to make predictions and recommendations. To fully participate in precision medicine, we must improve our collection and reporting of more patient information. We must also be knowledgeable enough about genetics and other professions to know when their information and expertise are critical to success.
We require precision medicine-focused tools and capabilities to level the playing field regarding accessibility and affordability. This will also enable more intelligent and simplified patient stratification. Precision medicine pushes us to stratify patient populations even more effectively than we proposed in our previous Fuel Your Future article. It helps ensure that individuals receive timely screenings and longitudinal monitoring aligned with their unique risks. This leads to earlier diagnosis and treatment, which can reduce the likelihood of advanced disease (Singh, 2024).
THE PRECISION MEDICINE ECOSYSTEM
THE BENEFITS OF PRECISION MEDICINE
Precision medicine is revolutionizing health care by making it more predictive, preventative, personalized and participatory. Here is how:
Targeted Treatment: Precision medicine tailors medical treatment to individual characteristics, increasing the effectiveness of treatments.
Early Disease Detection and Prevention: Precision medicine enables early detection of diseases. By taking a proactive approach, we can prevent diseases from progressing, potentially saving lives and reducing health care expenses.
Customized Medication Dosages: Precision medicine allows for customizing medication dosages to optimize efficacy and minimize adverse reactions, improving medication adherence and reducing the risk of complications.
Enhanced Patient Engagement: Precision medicine empowers patients by involving them in their health care-related decision-making processes. Access to personalized genetic information and treatment options makes patients more engaged and motivated to participate actively in their care.
Improved Patient Outcomes: Precision medicine is not just a theoretical concept but a practical tool that will improve patient outcomes by customizing treatments. This will produce higher treatment success rates, reduce side effects and improve overall health outcomes. This potential should motivate us all to commit to its implementation.
Reduction in Health Care Costs: Although initial implementation costs may be higher, precision medicine can reduce long-term health care costs by avoiding ineffective treatments, minimizing hospitalizations and preventing disease progression through early intervention and prevention strategies.
Advancement in Research and Development: Precision medicine contributes to advancing medical research and development by providing insights into the underlying mechanisms of diseases and individual responses to treatments. It positions audiologists to effectively treat the heterogeneous causes and manifestations of hearing loss on a more effective individual basis.
Precision medicine has tremendous benefits, but it also faces challenges.
The fundamental challenge is assimilating, analyzing and integrating genomic data, electronic medical records (EMRs), data obtained with mobile health devices and other data about hundreds of millions of people.
We also need more providers, including audiologists and otologists, who are educated and experienced in precision medicine.
Another essential challenge is the need for more AI-ready data. Data that is not AI-ready slows the adoption of AI, machine learning and precision medicine. Preprocessing will be necessary to extract meaning and ensure data usability from many diverse datasets.
Health care quality varies from region to region and person to person, so we must develop a universal precision medicine infrastructure available nationally.
An additional crucial challenge is appropriate participant inclusion, particularly regarding ethnic diversity, geographies and other demographics. This includes the medically disenfranchised who lack EMRs or ready access to the internet.
Finally, users of precision medicine must address privacy and security concerns.
WE MUST BRING THE POWER OF PRECISION MEDICINE TO HEARING HEALTH CARE.
Precision medicine represents a momentous shift toward more individualized care and the promise to revolutionize health care. Powerful computers armed with GenAI and the massive datasets of precision medicine can reveal long-hidden relationships, enlightening us with new knowledge about the causes and effects of diseases and health care and how to perfect hearing health care (HHC).
Presently, small practices don’t have access to the large patient datasets and computer and AI resources required by precision medicine to analyze these datasets. Large medical centers have these resources and are leading the development of precision medicine. Students interested in learning more about precision medicine should expand their knowledge and experience by acquiring externships and employment in these medical centers.
The breadth of precision medicine is creating new partnerships between scientists in a wide range of specialties, as well as people from patient advocacy communities, universities, pharmaceutical companies and others. Audiologists must become active participants and leaders in these partnerships.
The emergence of precision medicine will revolutionize the roles within the hearing health care system. For example, with its insights, we can minimize the need for cochlear and brainstem implant surgeries and instead empower audiologists to collaborate with geneticist partners to prevent, cure or manage these patients’ conditions. Educating yourself about genetics and other aligned professions is a must for thriving in the new health care ecosystem.
Precision medicine is transforming hearing health care. You will enjoy using its tremendous power to help your patients through improved diagnosis, prevention, cures and treatments. You owe it to your patients, your profession and yourself to stay abreast of developments in precision medicine and their applications to hearing health care.
Genomics is a crucial component of precision medicine, and its combined influence on HHC is snowballing. In the next article in our Fuel Your Future series, we will concentrate on genomics and its powerful potential to reshape HHC and improve your capabilities as an HHC provider.
Resources for Future Study
References
Young, A., Ng, M., (2023). Genetic Hearing Loss, National Library of Medicine, https://www.ncbi.nlm.nih.gov/books/NBK580517
Cerrato, P., Halamka, J., (2018). Realizing the Promise of Precision Medicine, Academic Press.
Cerrato, P., Halamka, J., (2023). Redefining the Boundaries of Medicine, Mayo Clinic Press
Nielsen, D. W., (2024). Genomics and Precision Medicine: The Astonishing Revolution of Hearing Health Care. A Call to Action for Audiologists! Fuel Medical Group White Paper, Fuel Your Future Series. 31 pages, Available free at: https://fuelmedical.com/wp-content/uploads/2024/08/fm_paper_genomics_and_precision_medicine_v2-2.pdf
Obama White House, (2015). FACT SHEET: President Obama’s Precision Medicine Initiative
Omichi, R., Shibata, S. B., Morton, C. C. & Smith, R. J. H. (2019). Gene therapy for hearing loss. Hum. Mol. Genet. 28, R65–R79 (2019).
Rudman JR, Mei C, Bressler SE, Blanton SH, Liu XZ. (2018). Precision Medicine in Hearing Loss. J Genet Genomics. 2018 Feb 20;45(2):99-109. DOI: 10.1016/j.jgg.2018.02.004. Epub 2018 Feb 16. PMID: 29500086.
Sprinzl, G. M., (2022). Personalized Medicine I Otolaryngology: Special Topic Otology, J. Pers. Med. 12, 1820. https://doi.org/10.3390/jpm12111820.