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Proselytizing Personalized Medicine

Kevin Davies

March 16, 2010 | First Base | According to PubMed, the first use of the term “personalized medicine” occurred back in 1990. The second happened a full ten years later. Since then, close to 1000 research papers and review articles have coined the term. Somehow, I expected the tally to be much larger, given how the concept of personalized medicine is so integral to our own health and that of the pharmaceutical industry.

There are many technological and cultural drivers of personalized medicine. In part it is fueled by the enabling technology of genomics, proteomics, model building, and molecular diagnostics, all of which offer the hope of providing consumers with predictive and preemptive information to manage their own health, or select from drugs (or drug dosages) better tailored to their genetic profile. Two years ago, we published one of the most exciting developments in that arena, the discovery of the KRAS biomarker that impacts the delivery of drugs such as Amgen’s Vectibix (see, “Amgen’s Personalized Medicine Story,” Bio•IT World, April 2008). It was also a recognition that the pharmaceutical industry’s blockbuster model is on life support, with the low-hanging fruit already plucked and safety risks emerging from drugs with broad indications aimed at a hugely diverse cross-section of the population. “There is no such thing as a safe drug,” Duke University’s Allen Roses said famously a few years ago, and it behooves the drug maker to know as much about its target population as possible, both to enhance safety and to expedite passage through the clinic.

Personalized medicine is the subject of this issue’s special report (see pages 27-38), in which we look at fascinating initiatives such as the Ignite Institute for Individualized Health and the Beyond Batten Disease Foundation, as well as air the views of a quartet of industry experts, consultants, and evangelists.

Life Decisions

Personalized medicine is also the subject of two timely books aimed at a broad readership. The Language of Life is Francis Collins’ follow-up to his best-selling The Language of God, in which he rectified his twin beliefs in science and religion. Collins, the new director of the National Institutes of Health, is a medical doctor, a gene hunter, and was famously “the field marshal” of the Human Genome Project. He wrote The Language of Life during a sabbatical between his long tenure at the National Human Genome Research Institute and his new appointment.

In customarily lucid fashion, Collins provides an enjoyable tour of the latest trends and controversies in personalized medicine, including the prospects for consumer genomics—Collins divulges some surprising information about his own genetic profiles obtained under a pseudonym—and designer drugs. The Language of Life is aimed at a large audience, and deserves to reach one. Ironically (and unfortunately) his federal appointment curtails his ability to promote the work.

Another excellent book just on the market is The Decision Tree, by Thomas Goetz, the deputy editor of Wired. One blogger suggested an alternative title: What to Expect When You’re Expecting a Long Life. Goetz’s thesis, which he laid out in the Huffington Post last year, is that personalized medicine isn’t just about choosing the right drugs at the right dose for the right patient. “It’s also about data—our personal data, the stuff in our medical records, as well as less clinical information like how much sleep we get or how often we exercise.”

Goetz lays out three rules for improving medicine: 1) Early is better than late; 2) Let data do the work; and 3) Openness is a powerful thing. He argues that our medical data can personalize our health care immediately, fed back into a virtual flowchart that we can construct to monitor and improve our health and lifestyle. There are short but insightful chapters on the problems and challenges facing drug development, but as Goetz says, “real personalized medicine should begin long before we’re faced with pharmacology.”

Goetz has a master’s in public health from UC Berkeley, which was doubtless influential in shaping his ideas. Although he comes from a family of physicians and health care providers, Goetz is adamant that, “when information technology offers so much assistance to people facing health care issues, our health is too important to leave to an archaic, insular, and information-poor structure. If there’s no longer a need to rely solely on a doctor’s advice for treatment and care, why should we be expected to artificially limit our options?”

This article also appeared in the March-April 2010 issue of Bio-IT World Magazine.
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