By James Etheridge

BioWorld International Correspondent

LYON, France - The future of medicine lies in personalized prevention through diagnosis of the individual's genetic risk, and that will be made possible by discovering the molecular pathology of disease and developing new diagnostic tools, Jonathan Knowles, president of global pharmaceutical research at the Roche Group, told the BioVision 2001 World Life Sciences Forum Friday.

The publication of the sequence of the human genome, the last bit of which will be revealed this week, would "enable us to understand the molecular pathology of disease," Knowles said, and that in turn would make it possible to identify the genetic risk factors for an individual in relation to a particular disease. Those risk factors indicated not only a person's susceptibility to specific diseases but also the extent to which he would benefit from a particular medication.

Understanding the molecular basis of a disease would make it possible to prescribe a more appropriate and effective treatment. Today, "one medicine is used to treat a whole range of genetically different individuals and the medicine is not equally effective for all." Even in pathologies for which effective drugs were already available, Knowles said, 30 percent of patients prescribed these drugs derived no benefit and a significant number of them suffered adverse effects. Tomorrow, however, "genetic information will give the clinician options" in the selection of the optimal therapy and "minimize trial and error in medical practice."

The genetic information, combined with increasingly smart diagnostics, would make it possible to obtain a more rapid therapeutic effect by better targeting, for example, a particular gene overexpressing a protein. By facilitating diagnosis and indicating genetic predisposition, knowing the molecular definition of a disease would make it possible to identify people at risk and take preventive action to delay or prevent the onset of disease.

According to Knowles, the chronology of patient care in the future will start with predisposition screening, targeted monitoring and prevention (whether by changes in lifestyle or nutrition or through medication). Only if prevention fails will the clinician proceed to diagnose the patient's condition and prescribe and subsequently monitor a customized therapy.

And, he concluded, "The development of powerful diagnostics will be the most important next development. Therapeutics will come afterward." n