Why gender differences hold the key to improving mental health through precision medicine
By Shahnaz Radjy
Precision medicine used to be referred to as personalized medicine. However, the latter term might be misinterpreted as prevention and treatments being uniquely refined and identified for individuals. That is not the case. Precision medicine is focused on effective approaches for particular groups of patients based on genetic, environmental, and lifestyle factors. It aims to offer medical care designed for optimal efficiency or targeted therapeutic benefit, often using primarily genetic or molecular profiling.
In medicine (but not only), individual-level observations and results often vary significantly from a group average. Precision medicine tries to find differences that can be generalized, understanding rather than underestimating them.
By describing and studying these differences, precision medicine wants to identify effective and patient-tailored (not individually, but based on grouped profiles) preventive and intervention strategies.
As an added bonus, precision medicine has the potential not only to improve health outcomes, but also to reduce costs.
How does precision medicine apply to brain and mental health?
Applied to mental health, precision medicine could revolutionize prevention and treatment.
For example, at New York-Presbyterian and Columbia University Medical Center, they carried out a study looking at a mutation found in individuals with schizophrenia and autism, and often linked to Amish communities.
Precision medicine can contribute to the definition of underlying mechanisms behind brain and mental health issues. As a result, earlier and more targeted prevention could be implemented. Furthermore, this enhanced understanding could help reduce stigma – often a significant obstacle to access to health care and support when it comes to brain and mental health in particular.
For example, if you imagine the brain as an electronic circuit, there can be short circuits that cause depression. But, just as there are different types and stages of cancer, there are different types and levels of these short circuits. Furthermore, some brains might respond to a specific kind of medication, and others will need a completely different approach. If we can identify the type of short circuit we are dealing with, we can design customized treatments and preventions to target that specific short circuit.
Technology plays a role, too. Machine learning, big data, and artificial intelligence can each play a role in identifying brain and short circuit types as well as designing targeted interventions.
An initiative at Stanford is working on that very approach for depression, using big and deep data to identify different types of depression so as to design adequate interventions for each.
Where do sex and gender fit into precision medicine?
Looking at sex and gender differences is a growing field of research, and sex as a biological variable was integrated into the United States’ National Institutes of Health (NIH) funding guidelines a few years ago. It means looking at conditions specific to men or women, illnesses that occur more frequently in women than men (or vice versa), variation in symptoms for women and men for a similar diagnosis, and differences in outcomes for women compared to men.
In the case of Alzheimer’s Disease, two-thirds of patients are women, and once diagnosed, women decline faster than men. We are only beginning to understand why that might be.
As precision medicine looks at groups of people sharing a common trait, sex and gender are an identifying characteristic that lend themselves well to study. That does not mean it is always easy – it isn’t! – but it is necessary as we strive to better prevent, diagnose, and treat conditions.
At the Mayo Clinic, for instance, radiologists are collaborating with neurologists to detect sex-specific alterations in brain structure linked to cognitive decline.
The Women’s Brain Project’s take on precision medicine
At the Women’s Brain Project (WBP), we firmly believe that factoring sex and gender differences into brain and mental health research holds the key to improved prevention, diagnosis, and treatment. As these elements are subsets of precision medicine, we strive to operate at the intersection of all these issues: As these elements are subsets of precision medicine, we strive to operate at the intersection of all these issues, and that is why the theme of our upcoming International Forum on Women’s Brain and Mental Health is “A Gateway to Precision Medicine”
If you want to find out more, and interact with experts such as Thomas Wilkens – world expert on precision medicine, you are invited to join us for our Forum on 8-9 June 2019, in Zurich, Switzerland. Registrations are open, and we look forward to intense, informative, interactive, and enlightening exchanges – plus a few surprises along the way.