Tuesday, April 14, 2009

What the !!@#$%^&*()_ing ~!@#$%^&*() Is Personalized Medicine?

Other than the catchphrase of the day in biomedical research. The dream of "personalized medicine" is the why for everything. Why sequence every human genome in the universe? Why, this information will herald in a brave new era of personalized medicine, of course. It's GenerationME ME ME!!!!111!!! meets medicine. Download the latest cure from my MY-Pod.

Most of the people talking about personalized medicine don't usually bother to explain what they have in mind, nor do they really seem to care whether that's clear. This leaves me confused about what all the fuss is about. Occaisonally I suffer from fits of sanity and it strikes me that maybe it's bad to be totally confused about the NEXTbigTHING about to hit your field.

So as always, I consult with all-knowing Goog-Oracle. Goog-Oracle spews forth some pretty trippy, but meaningless flow-charts, most wherein people are depicted by male/female icons from the restroom door. People with the gall to put their definitions into words come up with some pretty wishy-washy shit. Andy De of the excintingly entitled blog "Life Sciences and Healthcare Strategy", and self-proclaimed "visionary thought leader" has this to offer:

“Personalized Medicine means knowing what works, knowing why it works, knowing who it works for and applying the knowledge for patients”, is perhaps the most succinct articulation of P/M from the honorable Mr. Michael Leavitt, secretary of Health and Human Services (HHS). This implies delivering treatment to patients that is proactive, predictive, personalized and participatory unlike the status quo today."

What??? That doesn't sound very high-tech to me. It kind of sounds more like what I thought I was supposed to be getting from my family doctor all these years...apparently not:

"By way of the “trial and error” medicine (also sometimes referred to as “intuitive medicine”) practiced across the world today, the doctor makes a “most likely” diagnosis consistent with symptoms and them prescribes what he/she considers appropriate treatment comprising drugs, devices or surgery. If the treatment does not work and presents significant side effects or adverse events, the doctor most likely would alter dosage or prescribe an alternative medicine. This iterative cycle is repeated, until the diagnosis and treatment that actually presents the desired clinical outcome in the patient is reached. The paradigm has reached a point of diminishing returns as evidenced by the fact that most drugs prescribed in the U.S. today are effective in fewer than 60% of treated patients(2)!"

Wow. Holy shit! My doctor is a useless piece of garbage. We need to get these inept humans out of medicine and start replacing them with IBM(tm)adding machines computers as soon as possible! If personalized medicine = computerized/roboticized medicine, then give me some personalized medicine, double-time.


Corey said...

The stock example right now is warfarin. When a doctor prescribes this drug he has a wide range of strengths to choose from. Right now, he uses things like gender, weight, coagulation time to decide on the dose. Very often, this original dose will be wrong, either too much or too little. The doctor then writes a new prescription that is a little closer to the dose required. Eventually they will get to a dose that is within the therapeutic range required.
The new personalized medicine approach uses the same clinical information regarding weight etc., but also uses sequencing of a couple key genes involved in metabolism of warfarin. Using this added information, they are able to more accurately determine the dose on the first try, which is pretty exciting.