Academic Review 2024

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Personalised medicine in preventing cardiovascular disease The diagnosis of hypercholesterolaemia, which increases an individual’s risk to cardiovascular disease, showcases how personalised medicine can be used to effectively identify patients’ susceptibility to diseases. Hypercholesterolaemia leads to an increase in blood cholesterol which can get underneath the endothelium in the lining of the artery if the endothelium gets damaged (often due to high blood pressure). This leads to the formation of an atheroma (a plaque which forms on the endothelial lining of the artery). Calcium and fibrous tissue also accumulate, causing the plaque to harden, which narrows the lumen and reduces its elasticity. In turn, this increases the patient’s blood pressure, forming a vicious cycle, leading to even further endothelium damage. This may cause a clot to form, potentially leading to a heart attack Problems with privacy and data Although personalised medicine offers lots of benefits, there are a lot of challenges that must be overcome in order to maximise the value that personalised medicine may be able to provide to patients in the NHS. One major obstacle, especially in the NHS, is problems with trust. Jem Rashbass has claimed that in order to continuously develop personalised medicine, ‘It’s important to find and identify the right people and to do that you need molecular data and clinical data sets. But we have issues with patient trust security, and technology to overcome first’ (Armstrong, 2017). It is a serious request to analyse a patient’s genome, as this may be considered as very private information, and could also lead to catastrophic consequences if this information was distributed. Privacy within the NHS is integral as individuals may face embarrassment if private information is released. This could jeopardise the quality of healthcare within the NHS, as patients who are concerned about their sensitive information being misused may be less inclined to visit doctors or may choose to withhold information, perhaps resulting in less effective or potentially even harmful treatment. Furthermore, breaches of privacy and security inside the NHS have generated distrust, making people afraid to disclose genomic information for the purpose of medical research. Jem Rashbass has stated that there were ‘26 million GP records made accessible to

or stroke. A single genetic defect leads to familial hypercholesterolaemia (FH) and ‘it is estimated that around 1:250 of the general population have FH, with a possible 240,000 patients with FH in the UK’ (Qureshi, Humphries, & Gray, 2018). Furthermore, ‘those with monogenic FH have over a three fold higher risk of premature CHD and would be expected to lose roughly 10 years of healthy life as a consequence’ (Qureshi, Humphries, & Gray, 2018). By identifying the presence of the genetic defect, patients can begin early treatment and take preventative measures through lifestyle changes to control blood cholesterol levels lowering their risk of cardiovascular disease. This increases life expectancy, thus illustrating improved outcomes and supports the argument in favour of further integration of personalised medicine. strangers’ and a HIV clinic was fined £180,000 after it released data on 781 of its patients (Armstrong, 2017). As a result, in order to continue further research into personalised medicine, patients must be willing to share and trust the NHS to handle their data correctly, and the public’s anxiety about how their personal information is handled within the NHS must be addressed. For instance, the NHS has published that in July 2021 alone 3,032,917 people have opted out of sharing their data for the purpose of medical research. This greatly limits the potential of personalised medicine as lots of medical information is required in order to be able to make tangible progress and improve medical outcomes through personalised medicine. On the other hand, patients opting out reduces the chance of data leaks and disruption of patient confidentially. healthcare by assisting with research required for advancements in personalised medicine to occur. A journal article written by Isabelle Budin-Ljøsne and Jennifer R Harris suggests that, ‘To ensure that prevention strategies are efficient, citizens may regularly enrich and update their personal health information, including genetic risk predisposition information, through the use of technologies such as web-based interfaces, self-tracking systems, To combat the issue of a lack of data for medical research, citizens could be more involved in