The Problem With Personalized Medicine

gManZboy writes "Talk of individually tailored medical treatment isn't pie in the sky. This approach eventually will help us address risk factors even before a disease can invade our cells, and detect preclinical disease before it gets out of hand. What role will medical informatics play in this brave new world? Hint: Little data projects may be as important as big data projects such as gene sequencing. At a recent symposium on personalized medicine, Ezekiel J. Emanuel, MD, chairman of the Department of Medical Ethics and Health at the University of Pennsylvania, questioned whether it would make more sense to target all the lifestyle mistakes that patients make rather than analyze genetic defects. His view: 'Personalized medicine misses the most important fact about modern society--little ill health and premature death is genetic, much more is lifestyle and social.' Is Emanuel a dinosaur or a pragmatist?"

Comments

There would be no healthcare crisis in the U.S.

[Anonymous Coward]

if obesity could be rolled back to the levels it had in the 1970s.

 

Re:There would be no healthcare crisis in the U.S.

[Tsingi]

Give it another few years for Obamacare to come all the way online, and there may well be. ;)

(oblig. "I'll probably get modded down for this.")

Probably. The rest of the modern world all look after the basic medical needs of people, it's pretty much only the US that lets people die because they have no money.

Re:There would be no healthcare crisis in the U.S.

[SuricouRaven]

Ban? I think just not subsidising it would be a start. The US government spends rather a lot of money paying farmers to grow corn in order to force prices down - and cheap-as-dirt corn is why HFCS is so cheap, and thus so popular in processed foods and snacks.

Re:There would be no healthcare crisis in the U.S.

[aclarke]

The GGP said "modern world", which you're comparing to the "underdeveloped world". Therefore your response isn't really a fair one.

Maybe the point should be that only in the US do sick people undergo a lifetime of indentured servitude due to medical bills if they can't pay for insurance. In most other places, people don't have to bundle the choice to receive necessary medical care with the aftermath of crushing medical debt payments for the rest of their lives.

And yes, this issue does cause people to avoid the hospital until a little problem has become a big problem, in many cases fatal. Please refer back to Tsingi's "letting people die" comment. No medical system is perfect, but from my vantage point the American system is pretty messed up.

Re:There would be no healthcare crisis in the U.S.

[Greyfox]

Anecdotally a common problem.

Funnily how people will rabidly fight to preserve every egg that got a sperm in it, right up until the fetus squirts out of a woman's vagina. At that point it's either completely on its own or they actively work to kill it. Right up until it comes down with a terminal illness and wants some "medical lead" to end its suffering. Then it's back to it being immoral and illegal again.

Re:There would be no healthcare crisis in the U.S.

[ColdWetDog]

Furthermore, the ER is not the be all and end all of medical care. Treating chronic medical conditions from the ER isn't very useful nor satisfying to either the ER or patient. US FEDERAL LAW STATES ONLY THAT HOSPITALS HAVE TO TREAT PATIENTS FOR EMERGENCY CONDITIONS. Once the "emergency" is over, they don't have to treat you although it is often illegal to just dump a patient out in the street (those tend to be state laws).

And to continue - just because the ER has to treat you doesn't mean the hospital won't bill you. And try to collect on the bill.

So the stupid meme of the US has a health care for all is valid only for a very narrow definition of health care.

And yes, Virginia, there is a crisis in the US healthcare system. Not only do we NOT cover a significant portion of the population, we DO pay more to do so without any measurable benefit whatsoever.

Excuses sell better than solutions

[Anonymous Coward]

Everybody knows this, but medicine is a business first. Excuses sell better than solutions. End of story.

Practical advice is not what people want

[Anonymous Coward]

Emanuel is right, but experience tells us that people don't want straight-forward advice about not eating deep-fried butter or exercising more. They want to do it anyways and be saved by medicine when it catches up to them.

What Personalized Medicine Is For

[Samantha Wright]

...Emanuel seems to be missing it by a mile.

This field is for dealing with the little ugly gaps that neither broad pharmacology nor lifestyle adjustment can correct. Take the case of antidepressants, for example: they're extremely finicky (not all work in all people) and have a huge cost in side-effects before the benefits arise. It is an extremely high cost to both the patient's health and the support system to cope with a bad choice of antidepressant. The basis of this fickleness is genetic, and running the right test in advance can prevent bad combinations.

Personalized medicine is not a cure-all, it's a very precise tool in drug design and selection. I'm sure that won't stop lazy physicians and marketers from calling the regular diagnostic process "personalized," though.

Not true

[rsilvergun]

the 'healthcare crisis' is because the nature of healthcare changed and the delivery mechanism did not. In the 1970s, healthcare was very limited. A doctor could set a bone, stitch you up, and blast you with radiation hoping for the best. In 40 years we've moved to things like personalized medicine (where for the price of $10,000 a month an aids patient can thrive, plus a raft of preventative medicines and maintenance medicines. Do you see the shift? We've gone from caring for a few major disasters and making you comfy when you die to maintaining the human body like you would any other machine.

An insurance model for delivering healthcare works for disasters and a one time end of life expense. It breaks when you're using healthcare for maintenance. The thing anyone without socialized medicine is, unless you're so rich you can drop $10k/mo, you don't really have healthcare. Because as soon as you need it, I'm mean you're really going to use it and use it regularly, your insurance provider is going to take it away. That's why America socialized medicine... for the elderly. But even they're going to lose it soon. Just you wait. You think it's there, but it's not. And by the time you realize it, it'll be too late. Poverty will crush you and you won't matter any more. You'll just fall by the way side.

Re:Because we'd all live forever?

[Anonymous Coward]

We are all, one way or another, going to die soon anyway. Many of us are born with incurable progressive ageing and may be prone to cancer, heart disease, Alzheimer's, etc.

Some people want to stay alive for longer than you might want them to. One day, you might be fighting to stay alive too (or maybe you don't think so - but maybe you'll change your mind in 50 years' time). It's not as if something better is waiting for them.

The healthcare crisis in the US is the same as all crises: the introduction of profit motive. Whether that's through the privileges of nomenklatura or shares in US health insurance, it always goes wrong in the long run.

Re:Because we'd all live forever?

[InsertCleverUsername]

2) Huge amounts of resources spent (about half of all healthcare spending) on dragging out the process of dying for people who are, one way or another, going to die soon anyway. Most of them are geriatric patients with incurable progressive conditions: metastatic cancer, congestive heart disease, Alzheimer's, etc.

Better lifestyle practices will give us longer, healthier, and for many of us happier lives. They won't make us invulnerable nor immortal. They won't keep our families from bankrupting themseves trying to add one more week of misery in ICU when our time comes.

Precisely. The biggest reason we spend twice as much as other countries on healthcare, yet find ourselves in the company of some third-world countries in outcomes, is that we blow horrible amounts of cash on unnecessary (read CYA for lawsuits) tests and ignorant "futile care" that tortures the dying in order to extend their lives a few months. More here: http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/

Wrong question but right answer

[RandCraw]

The goal of personalized medicine is to identify which genomic pattern in a population will respond to a given drug, or identify which drug will work for a given person's genome. It has nothing to do with improving public health policy and only tangentially with reducing health care costs. It has a lot to do with reducing time-to-treatment and making drugs more efficacious.

Emanuel is right that it's nuts to waste money on gene-based treatments which target only the symptoms of disease, when fixing the disease itself necessarily requires a change in lifestyle, which is something that technology cannot and will not fix. Once we accept this, the next step is simply, "How"?

All western countries are healthier than the US. Let's start by looking at what they're doing and then reward americans for doing more of that.