Thanks for visiting my blog - I have now moved to a new location at Nature Networks. Url: - Please come visit my blog there.

Monday, March 9, 2009

Personal Medicine - towards efficient medicine

I've posted a couple of thoughts on Personal Medicine, lately. They've been fairly popular, and obviously controversial enough that people have taken the time to comment. (I really appreciate that, by the way!) Those comments are very useful in giving me an opportunity to think about the subject in ways I hadn't considered. (Thanks, again, to those who chimed in on the last two posts!) So, I have at least two more topics I want to cover. The first one is "efficient medicine."

All this talk about personal medicine is interesting, because it's relatively obvious what everyone means: using a patient's genomic/transcriptomic information to make personal health decisions that are tailored to suit the patient's personal needs. Hence, it's personal medicine. However, the question really has to be asked why we're doing it. I contend that the personal medicine is a technique, but the underlying goal is really "efficient medicine."

By efficient medicine, I really mean efficiency in several ways:
  1. More efficient use of medication (1): treating only those people who will benefit from the treatment.
  2. More efficient use of time: automate health care so that we can figure out the right treatment more quickly.
  3. More efficient use of resources: treat people once with the right medication, so that less time needs to be spent in clinics and hospitals
  4. More efficient use of medication (2): ensure people treated with medications won't suffer from adverse effects, which has a human cost as well.
  5. More efficient use of doctors: Allow doctors to spend less time trying to diagnose problems, and more time trying to figure out how to solve them.
I'm sure I could go on, but by now everyone gets the idea. Efficiency means something different to everyone in the medical chain of command, yet I'd like to think everyone is striving to provide more efficient medical care. Whether the medical funding agency wants to save money by not treating non-responders to a drug, a hospital wants to save resources by pro-actively treating an out-patient (metabolic disease), or whether the doctor wants to spend less time trying to figure out the root cause of a patient's problem (eg. Crone's disease), knowing what's going on at the genomic level will make the medical care more efficient for everyone involved.

So, let me re-iterate my other points from the past few blog items: We are near the tipping point where the cost of personal medicine is becoming sufficiently low that the efficiency benefits from taking advantage of it will have a measurable effect.

Once that takes place, it will be a tide that washes away the in-efficient medical practices of the past. Medical funding agencies won't fund doctors or medical practices that waste time or money, and that will force through changes that make personal medicine the only way to do business.

Again, I'm not arguing that doctors are incompetent, just that personal medicine will change the baseline level of efficiency we demand, and that MDs will need to cope with that change.

And, as a corrolory, that's going to lead to an aweful lot of medical funding agencies to start funding lifestyle changes. (Go to the gym 3 times a week, and save 50% on your insurance....) Change is coming, people... and you don't need to be an MD or a PhD to see it.

And speaking of efficiency, I have a few more things I need to get done this afternoon! Back to the grindstone...



Blogger Lab Rat said...

Having read through your posts (and some of the comments) on 'personal medicine' I thought I'd just add my thoughts which are that, quite frankly, if it does happen, it's going to take a while. The human genome is just so *big* and complex and interacting in strange ways that people never thought it would. It could take a while before it can provide meaningful assays.

I can imagine it's a fascinating area of research though.

March 11, 2009 9:47:00 AM PDT  
Blogger Timothée said...

Hi Anthony,
I read with great interest your posts and the comments about personal medicine, and I have to say that I agree for the most part.
I am thrilled like you are when I think about the improvement that could be made in cancer treatment and any other related genetic disease. Or when I hear about molecules that shouldn't be used for some variant carrier.
But I Have to say that the idea of an automated health care give me the creep (remember Gattaca?).
There is in the human body some processes that involve little or no genetic at all. The immune system is a good example: two exact same genetic background can develope different allergy if raise in different environment and no genetic analysis will give you any good insight about it.
What I see in genome/transcriptome analysis is a new powerful tools (getting cheaper and cheaper) that will give the MD a better insight on some chosen situation. And like with the X-ray, MRI and even the blood test MD should use this tool with caution. because like any tools there are some limitations and we don't understand them completely yet.

March 11, 2009 9:28:00 PM PDT  
Blogger Timothée said...

Ho!! and by the way, I hope the symposium was interesting and if it was maybe you could give the one that couldn't come a summary ;P

March 11, 2009 9:30:00 PM PDT  
Blogger Anthony Fejes said...

Hi Lab Rat,

Thanks for your comment. I agree that the genome is a massive "document" and that implementing things that are useful will take some time, although I think that a lot of the high penetrance genes will begin to make their way into the clinics quickly. The low penetrance genes or those with complex phenotypes will take a long time to bear fruit, however. So really, it'll take a while for us to harness the full benefit of this research, but in the short term, we already have some small spill-over which will only get bigger.

A couple of quick examples of diseases that are being treated, prevented or predicted currently include Phenylketonuria, Cystic Fibrosis, Huntington's, Breast cancer (BRCA1/2), and, apparently 70+ others that are already in use.

March 12, 2009 11:24:00 AM PDT  

Post a Comment

<< Home