Personalised Medicine from a Nordic Perspective

The technical revolution has generated large amounts of data in healthcare and research, and a rapidly increasing knowledge about factors of importance for the individual’s health. This holds great potential to support a change from the one-size-fits-all paradigm to personalised or precision medicine, to guide and thereby improve each health decision of expected benefit for the patient. The SARS-CoV-2 pandemic has contributed to a great public and political awareness of the importance of personalised medicine, where the influence of host factors like age, sex, obesity, smoking, co-morbidities etc. confer increased risk of serious COVID-19 illness. It is expected that in the near future, a more systematic and data-driven approach for prediction and risk stratification of COVID-19 patients and many other patient groups, will increase and improve due to better understanding of disease pathology, including the influence of genetic variability and biomarkers on disease risk and outcome. The Nordic countries have unique welfare systems with general access to healthcare, and longitudinal nationwide health databases and biobanks. This infrastructure combined with unique person identifiers creates an optimal setting for personalised medicine development, and the Nordic model of research, translation, care and education can serve as a forefront example for the rest of the world. The course in Personalised medicine from a Nordic perspective will introduce, describe, define and discuss the concept of personalised medicine from the aspect of the patient, health-care and the infrastructure available to generate a learning environment that is integrated with everyday care of patients. The course also covers communication of risk and the ethical, legal and social aspects of personalised medicine and presents examples where personalised medicine approach is already used in routine care. The course was initiated by Faculty leaders in the Education Working Group of Nordic Medical Schools and received funding from the Joint Committee of the Nordic Medical Research Councils (NOS-M). Experts from all the Nordic countries participate in the course: Saedis Saevarsdottir, Sisse Ostrowski, Hans Tomas Björnsson, Richard Rosenquist Brandell, Henning Bundgaard, Engilbert Sigurðsson, Aarno Palotie, Ole A Andreassen, Runolfur Palsson, Alma Möller, Søren Brunak, Johan Askling, Carsten Utoft Niemann, Rudi Agius, Sofia Ernestam, Saemundur Oddsson, Henrik Ullum, Kari Stefansson, Patrick Sulem, Simon Rasmussen, Jens Lundgren, Anders Perner, Merete Lund Hetland, Heidi Bentzen, Henning Langberg, Sigurdur Kristinsson, Thor Aspelund, Jeanette Knox, David Arnar, Sigurdis Haraldsdottir, Hakon Heimer, Lone Frank, Mette Nordahl Svendsen, Bjorn Hofmann, and Morten Søgaard.

• Introduction to personalised medicine
• This module will introduce the concept and methods of personalised medicine, including terminology and definitions, with emphasis on how the infrastructure of the Nordic countries facilitates developing and implementing personalised medicine in collaboration. Examples of applied personalised medicine in the Nordic countries and unmet needs in common diseases, where personalised medicine can be the way forward, will be described and discussed.
• Health information used in personalised medicine
• The module describes what kind of information is useful to tailor the care of individuals, with focus on the potential of health data that is already collected, and the benefits of using such “real-life” data compared to clinical guidelines based on evidence from randomised clinical trials, but also the importance for data “cleaning” to increase the usefulness of such data. Data analysis is key to unfold the potential of collected health data and the module introduces data science as a tool to apply data-driven clinical decision making and thus personalised medicine.
• Biomarkers, genetics, and omics
• The module describes definitions and identification of biomarkers and how these can be applied in precision medicine, as this part of personalised medicine is often referred to today. Genetics have a fundamental role in personalised medicine, and the students are expected to have a basic understanding of terminology, definitions and methodology, while the focus here is on its use and potential in personalised medicine (other courses can be taken to gain that knowledge basis if needed). A similar approach is taken for the rapidly developing field of ‘omics’ (genomics, transcriptomics, proteomics, metabolomics etc), since this field could well fill up a course on its own. Thus, the module describes analyses and interpretation of biomarker, genetic and omics data and their implications for care. In addition it describes how open data sources are used for analyses and interpretation of such data.
• Evidence and documentation for clinical efficacy of personalised medicine
• The module will describe and discuss what “evidence” is and the challenges and opportunities and shift in the paradigm that data-driven personalised medicine has introduced. Furthermore, evidence-based medicine including different trial designs and novel trial designs will be described and discussed. The challenge for personalised medicine and novel trial designs to generate good enough evidence for clinical implementation is discussed from a clinical and legal perspective. Finally, the innovation pipeline from research to clinical practice is also described and discussed.
• Communication in personalised medicine
• The module will introduce, describe and discuss risk – a cornerstone in personalised medicine. How is risk calculated, communicated, inferred and interpreted? Furthermore, patient-centered care – a complement to personalised medicine – and the pro’s and con’s of screening for diseases will be described and discussed.Finally, the role of the media for the hype and horror sometimes introduced by novel healthcare technologies will be discussed.
• Ethical, legal and social aspects of personalised medicine
• The module will introduce and discuss the ethical and social aspects of personalised medicine in research, clinic and society as well as its impact on health economy and prioritisation. The legislation and regulation of personalised medicine in the Nordic countries will be described and discussed. Furthermore, the industry interest in and collaboration on health data and biologic material will be described and discussed focusing on challenges, possibilities and perspectives. Finally, the module concludes on future perspectives for personalised medicine in the Nordic countries.