Personalized Medicine vs. ObamaCare
Personalized medicine is the future. It is where the science is going. It is where the technology is going. It is where doctors and patients will want to go. Yet unfortunately for many of us, this is not where the Obama administration wants to go.
First, the good news. Biosensors that can be worn on clothing or jewelry, or held against the skin by a Band-Aid-like patch, or inserted beneath the skin are capable of monitoring a whole host of chronic diseases. Among the technologies that have been, or soon will be, developed are devices that can continuously monitor the blood glucose levels in diabetics; the rate of breathing, blood oxygen saturation, etc., of asthmatics; and the heart rate and other parameters of patients with heart disease. There are even heart attack and stroke attack detectors. In some cases, personalized devices can activate therapies. A wearable, automatic insulin pump can be coupled with a blood glucose measuring device to create a virtual artificial pancreas. (See this fascinating summary.)
The science of genetics is also about to explode. There are as many as 1,300 genetic tests currently available that relate to about 2,500 medical conditions. Gene tests can predict your probability of getting particular types of cancer, whether you will respond to routine chemotherapy or whether there is a special therapy that only works on people with your particular physiology. The days when experts argued over whether men should get a prostate cancer test could be long gone. A simple test can tell if you have a high probability of contracting the disease, or a low one.
We’re not that far away from the day when:
Sequencing the personal genome will take an hour and cost perhaps $300, or less than an MRI. It is not too much of a reach to postulate cell-phone-sized analytical devices able to test for 500 biomarkers that cross the body’s more than 50 organs in a single drop of blood.
All this is great news. Unless you happen to be in traditional Medicare. Or in Medicaid. Or unless you acquire subsidized insurance in a health insurance exchange. Or in some cases, even if you get health insurance from an employer.
So what exactly is personalized medicine?
I gotta be me
[It] means gathering specific physiological information pertaining to individuals, compiling that information into a digestible and actionable form, and presenting that compiled information to the individuals themselves (and to their doctors or other designated agents), in order that they may decide what action to take on behalf of their own well-being.
Today, individualized medicine…is feasible for the first time in history. It is feasible because of the fortuitous convergence of several technologies, including the Internet, ubiquitous wireless communication, massive data processing power, new physiologic sensors, the power of genomics, social networking, and smartphones (i.e., personal information and communication systems)…[T]his remarkable technological convergence has made it possible to devise systems with which people can control their own healthcare in ways that were unimaginable a decade or two ago.
In thearea of gene therapy, progress has been slow, but in some cases remarkable. For example, there is now a genetic test that can determine with uncanny accuracy whether a patient’s eye cancer is curable or fatal. In another path breaking example, consider the case of Dr. Lucas Wartman, a young physician who developed adult acute lymphoblastic leukemia, a disease that is usually rapidly fatal, and for which there is no effective treatment. After his colleagues at Washington University worked round-the-clock for many days using the university’s 26 sequencing machines and a supercomputer:
[T]hey discovered a single gene mutation in his cancer cells that was producing a protein that appeared to be stimulating the cancer’s growth. It turned out that a new drug existed that was targeted specifically at shutting down the offending protein, a drug that to that point had been used only for kidney cancer. When they administered the drug to Dr. Wartman, his cancer went into complete remission. [more]
Now for some bad news. In an interview with CNN the other day former White House health adviser Ezekiel Emanuel called “personalized medicine a myth.” According to his own center’s summary of the interview:
[He] characterized excited public discussion of the potential of population-wide individual gene-based medicine as “hyperbolic.” He said tailoring medical treatments to individual characteristics of each patient is both overly optimistic and cost-prohibitive and likened the process to buying a custom-made suit versus one off the rack.
But if custom-made suits fit better and look better, what’s wrong with that? Ditto for health care. And if individualized care is better and more promising care, how does Emanuel know it would be cost-prohibitive? Even more puzzling, given the spectacular results with eye cancer, why would anyone — especially an oncologist — react so hostilely?
The answer is: ObamaCare’s entire approach to cost control is premised on the idea that we are all alike. And if we aren’t alike, everything they are doing doesn’t make sense. More about this in my next editorial.
Well-presented, John. The rapid pace in this area promises more effective care in at least some critical situations. The falling cost of sequencing can (not necessarily will) lead to gathering DNA data as a part of routine care. The economics clearly will be confusing for a while as the “up front” costs and search technology come along but if the cost controls arrive first we may never realize the possibilties!
George
Another area of medicine that is often overlooked or dismissed is stem cell therapy. This is barely approved by the FDA (most applications are probably not approved). Stem cells are proliferated from a patient’s fat or blood cells and then injected back into the area that needs them. This is not reimbursed by insurance. People who get this are usually paying out of pocket. Since paying out of pocket for unapproved medical procedures is frowned on (on many different levels) by the U.S. Dept. of Health & Human Services, it’s unlikely to take hold.
I must be naive for thinking that indiscriminately blasting people with chemo, or facilitating drug-resistant bacteria was a bad thing through broad spectrum treatments.
There’s a school of thought that standardization and commoditization of treatments would improve the practice of medicine. To some degree, this may be true. But, as Hoover suggests, one-size-fits-all does not actually fit all — unless all people are exactly alike.
I am very excited about the coming medical breakthroughs! As you mentioned genome sequencing, I was just recently reading an article regarding the subject:
I am also excited about RNAi innovations and pathway inhibitor drugs!
Well presented. How will pharma respond both in protein specific drug development? How will this work financially with more drugs for smaller populations?
This is all very exciting and makes me want to believe there is a chance that our system will turn around and collaborate with these improvements and new breakthroughs. If only the government would adjust to new technologies and innovations that could lower costs and improve the quality of care, our health care system could see major changes overall.
Can’t wait to read future posts on this matter!
Politics has turned all science, including medicice, into the research of the politically viable rather than the discovery of the possible. Hence we get people like Mr. Emanuel saying it is better to ignore any possibility of better medical service, and instead persist in using the same methods we have now, but hoping minor changes will improve them.
a one-sized-fit-all approach works for no one.
This is a very disturbing post.
I feel that the current system is hostile to personalized medicine, less that only this administration is.
I also se hope for personalized medicine in the current system if it can be properly documented and pitched to insurance companies. Why wouldn’t cheap sequencing be accepted as a valid tool?
John and Colleagues: You have described the most important medical science breakthrough of our time. It is the equivalent of moving from believing that disease is caused by miasma, curses of witches, or some other non-scientific cause to discovery of germs as causes of disease. We will look back in a short time to the practices of treating everyone with surgery, chemo and radiation without knowing which ones will actually benefit as a cruel and expensive practice. We have to help all parties acknowledge that Personalized Medicine is curative, not just palliative; the ultimate low cost solution.
Obamacare, and Ezekiel Emmanuel’s place in it are a grave danger to patients. Because this new science is so laden with prejudices and fears, it is going to take all of the main parties in healthcare to actively seek out and use Personalized Medicine. Patients, Purchasers, Plans and Providers are all in this together.
We are developing a “Bridging Conference” about pulling the biotech world and the healthcare delivery world closer together, which we will follow with a full court press to have patients and insurance enrollees demand their genetic history and genome analysis be included in their diagnostic step and the following therapy.
Regardless of who wins in November, we have to get rid of Obamacare–the equivalent of the Inquisition’s allegiance to one particular version of the Bible.
Wanda J. Jones, President
New Century Healthcare Institute
San Francisco, CA
The key part of Emanuel’s statement:
“He said tailoring medical treatments to individual characteristics of each patient is both overly optimistic and cost-prohibitive and likened the process to buying a custom-made suit versus one off the rack.”
Translated, that means that GOVERNMENT wants to be the SOLE decider of who gets what medical information, drugs, and treatments in healthcare; certainly not the patient, for whom his or her own medical information is beyond their ability to properly understand or utilize on their behalf. Also, if patients are individually obtaining, investigating, and designing their own medical information and treatment regimens with the help of their own physicians and medical specialists, then the GOVERNMENT isn’t doing it … or doing it to a far lesser degree than it wants … which means it’s VERBOTEN!
When this White House tells you something isn’t good for you – whether it’s foods or healthcare – RUN, don’t walk, in the opposite direction. FIND OUT FOR YOURSELF.
Whilst to you make an impassioned plea for personalized medicine, the reality is that there is very little evidence that this brave new world of medicine provides any of the benefits you postulate. Dr Emanuel is correct that with the currently available evidence, personalized medicine is a myth. That is not to say that ongoing research will not demonstrate benefits. However we need to ensure we are not dazzled by the hype but rather rely on the science.
Excellent post, John. You point out the dangers of health czars like Dr. Emanuel, who is the darling of the media, especially the New York Times, deciding who has a life worth living. Emanuel at least has an MD degree and “prestigious” credentials’ which makes his pronouncements much more dangerous. But then you also have the likes of cars czars like Steve Ratner, the darling of Morning Joe, telling us which sick elderly patients we cannot afford any longer. Ratner is just taking the role that Joe Califano — the old Chrysler’s car czar — took in the 80’s and 90’s. The reality today is that economists, politicians, NY Times editors and reporters, and every other non-doctor gets to tell doctors and patients who gets to live and who gets to die. When is the last time you ever heard a representative of some medical organization standing up for a patient’s right to live?
Doctors in general have given up fighting for patients.
So,let car czars, MBAs, eonomists, and reporters treat them when they get sick!
We can’t afford genomic medicine, but we damn sure ought to buy Chevy Volts.