Genomics promises the next wave of medical innovation. It will remake clinical care. At least that’s what the genomics researchers say.
Today, medications get tested on thousands of people. Hopefully, safety and efficacy in thousands of study patients means medication will work on each individual patient.
Can we do better?
Genomics
Imagine if we could match someone’s exact genetic coding with a perfectly suited treatment? Genomics promises to do that, soon.
Personalized medicine, pharmacogenomics, presupposes individuality. People respond uniquely to medication. Currently, we aim for similar targets in every patient on a particular pill but are not surprised that individuals respond uniquely.
It explains why, all things being equal, a patient needs more medication than her sister for the same condition.
Not Cookbook Medicine
Genomics undermines a powerful movement. Evidence based medicine (EBM) has preached standardization, clinical practice guidelines and ‘quality’ for decades. Evidence based medicine swelled on the imprimatur of statistical analysis.
Devotees believe the path to excellence and efficiency lies on the narrow road of crisply defined process.
Top-Down Control
Academics, central planners and politicians love EBM. They wield EBM to proscribe medical deviance. Clinical judgement takes the hindmost. Planners stand on giant studies and proclaim ideal treatment and best practices. Politicians lean on wayward physicians who allow too much patient choice in treatment, too much individuality.
Genomics delivers a new songbook. It sounds like old-fashioned pathophysiology that EBM discarded in the 1980s. Pathophysiology irritates statisticians and politicians. It encourages clinicians to think instead of memorizing clinical guidelines. Thinking is messy, hard to control.
Future
Genomics might become just another cookbook. It might dictate treatment based on computer analysis of patients’ genomes eliminating clinical judgment. Regardless, it will still ruin the one-size-fits-all approach clinicians get graded on now.
Hard core, individualized science might make a comeback. It will change everything. And it won’t be cheap.
photo credit: telegraph.co.uk.com
It sure won’t be cheap! It will presumably cost more than the multitude of medications supported by EBM, likely benefitting the industry more than the consumer. Meanwhile, there are “one-size-fits-all” remedies that do not benefit the industry, such as moderation in consumption, faithfulness in relationships, and intentional purpose in using the gift of a day, which cost no money but add more to life than designer drugs.
Great comment (as always)!
Good point about no-cost remedies garnering very little attention from industry, government, providers and patients. Your list made me think about the difference between a life rule, or creed, versus cookbook medicine. Your no-cost suggestions seem to fit with the former but fall within the ambit of clinical care no less.
Thanks so much for reading and commenting!
Shawn
See, for all of the support for the “scientific” basis of EBM, one very large central tenet of the scientific medicine is conveniently ignored:
Experimental results must be repeatable and reproducible.
The clinical guidelines and proclamations from governments and academic bodies fail to recognize this very important concept. Many of the clinical guidelines we use are based on billion-dollar studies funded by trillion-dollar organizations. Statistical analysis says that the bigger the study, the more relevant the results, which is very conveniently pointed out by those who fund these studies and benefit from the results. But how can anyone reproduce these studies except those who originally devised them, or others who have the means to do so usually for economic gain.
Another great point (in addition to your comments on the “Healthcare’s Only Hope…” post).
The mega trials also never include the oldest of our elderly patients. We get crisp guidelines that often mean nothing for those over 75 with co-morbidities.
Thanks again for taking time to read and comment!
Shawn