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The Limited Potential of Personalized Medicine

March 20, 2011
By

Have a simple blood test so your healthcare can be personalized. Sounds great, doesn’t it?

This is the hope of the supporters of genomics, the emerging science analyzing the DNA structure of humans.

Over 80 mutations have been discovered that are associated with obesity and diabetes. Each mutation accounts for no more than 1% of the explanation for obesity and 5% for diabetes. Asthma was also found to be genetically complex with over a dozen DNA variants discovered already.

Therefore, tens of billions of research dollars later, the genomic scientists have told us common chronic diseases are complex and caused by many factors. We knew that before they started.

The unspoken assumption of this whole line of research is that early detection would make some extraordinary difference in the lives of people, and that knowledge of future risk is always a good thing. In the geneticists’ world view, a child would have a complete battery of blood tests looking at her risk for dozens or even hundreds of diseases. A probability estimate would be generated saying something like your child is at 30% increased risk for asthma, 5% decreased risk for obesity, and so on. Also assumed is that insurance companies will pay the thousands of dollars charged for a comprehensive battery of tests.

The other driver of funding for this research is the patient empowerment movement. Americans are bombarded with statements such as Take control of your health and Live  your life on your terms. These statements imply that future events are avoidable and mostly within an individual’s control, which is a false hope in many cases. No advertiser talks about humbly accepting the highs and lows of the human lifespan, including having little control over how and when we die.

As for caring for a patient destined to develop asthma, I say just wait until she wheezes then we’ll deal with it.

I say prove to me that the knowledge of a small increased risk of obesity and diabetes will actually motivate a group of people to turn off the TV, put away the snacks, go for a long walk, and really lose weight

A recent review of the current state of genomics concluded:

     What is becoming clear from these early attempts at genetically based risk assessment is that currently known variants explain too little about the risk of disease occurrence to be of clinically useful predictive value.

Once again, well-meaning basic scientists have pushed American healthcare (and other countries) closer to bankruptcy. With the extraordinary overall debt of the U.S. government actually receiving a little consideration now, eliminating this line of research that is going nowhere except to make American healthcare more expensive would be a great place to start.

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2 Responses to The Limited Potential of Personalized Medicine

  1. Josh Trutt, MD on March 23, 2014 at 12:10 pm

    It seems to me that your article confuses research dollars with healthcare spending. If you feel that Medicare and Medicaid should not be paying for untargeted genomic testing for (as opposed to targeted testing such as for BRCA1 or Cystic Fibrosis), I can understand that– though the point seems moot, since Medicare and Medicaid DON’T pay for such untargeted testing:
    https://oig.hhs.gov/oei/reports/oei-07-11-00011.pdf

    If you are arguing that no federal research dollars should go into genomics research, when gene therapy is quite obviously the future of medicine, that is hard for me to swallow.

    • Richard Young MD on March 24, 2014 at 8:56 pm

      I am not arguing that no federal research dollars should go into genomics. However, unless a disease is clearly genetic in nature with ideally a single gene responsible, perhaps two or three, then gene therapy is absolutely NOT the future of medicine. The gene people are discovering what we’ve known in family medicine for years. Reasons why one person develops the bad sequelae of one or more chronic diseases are multi-factorial, involve numerous genes and even more external complex factors. Let’s not waste our precious healthcare resources trying to modify genes that are a minor contributor to a patient’s health state.

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