February 28, 2015

Is Precision Medicine for the Masses?

Since the President's “State of the Union” address, the medical community, including the drug industry has been licking their chops in anticipation of the money to be gleaned in the process. Even patients are wondering how quickly this will be available.

I admit it sounds exciting until more information comes to light and there are many variables that may not have been considered. With each individual being so different, how will doctors be able to know which medication is applicable. Precision medicine is still a buzzword at present and it will be at least a decade, if not longer, before there will be a practical application. Medications will need to be developed to cover the different types of individuals and since there will be less needed; the costs will be significantly higher.

Doctors writing about precision medicine at this time, like Dr. Pelzman, are creating pie-in-the-sky scenarios that may never happen. For this to be successful, new specialists will be needed that understand the relationships involved in the individual genomes. Add to this, ethnical variances and other factors, and who will be able to determine what will be best for the individual patient. Doctors presently have problems with people with different ethnicities.

This will tend to exclude the elderly as few clinical trials are done to determine the effectiveness of medicines for the elderly.

Precision medicine cannot be precise if the implications/malfunctions of specific DNAs/RNAs/Proteins identified in an individual patient are unknown. With more than 20.000 genes, many of them with allelomorphs (alleles) in every human being, the number or permutations are astronomical and do not with our current limited molecular biology/physiology/pathology understanding allow doctors to select the information most relevant to a particular patient. An overload with chaotic information will make the doctor just as ill as the patient he/she is trying to help.

Then when the doctor prescribes one medication and sees no improvement, will they continue as they do today, of prescribing another medication in addition to (stacking) the current medication in hopes that the combination will solve the problem. With the cost of the two medications, or even more, the patient will not be able to afford the treatment.

There may be a place for precision medicine, but too little is known at this time about the under pinnings of how some medicines react positively for some individuals and negatively for others. Add to this allergies and the world of medicine may not be as precise as some are hoping.

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