The term personalized health care is often used these days. It is an exciting outgrowth of our better understanding of the human genome. We now know that our genetic makeup impacts the way we respond to certain treatments.
For example, in this month’s issue of Biological Psychiatry, there’s an article (Lee et al. 2007) about a link between a certain genetic variant and the drug Zyban, which helps people quit smoking. It seems that people who have the variant were less likely to have resumed smoking six months after taking Zyban.
There are numerous medicines doctors prescribe now only if a certain genetic condition exists. In other words, treatment is personalized based on genetic history of a patient.
I worry when we use the phrase personalized medicine, for some, it creates a mental picture of a patient having one-of-a-kind pharmacology developed specifically for them, based on their phenotype, environment and genetic make-up.
That model, while appealing, raises doubts. Intuitively, people develop questions about the scalability and sustainability of trying to treat a population of people in that fashion.
The vision we are moving toward, in my mind, is best described as mass personalization. Using a thorough understanding of a person’s genetic and clinical history, a doctor will select a combination from a group of biological and chemical treatment tools.
I sense our vision will be better understood and accepted if we begin to paint a picture more familiar and comfortable to patients, providers and payers. As consumers we have become quite familiar with mass customization in many of the things we purchase.
When I bought my first set of golf clubs, I bought a set the golf professional had on the shelf. After many years, I decided to buy new ones. The technology has improved and there were several aspects of my game that would fall into the category of needing treatment.
This time, I was confronted with a different experience. The golf professional and I measured my height and arm extension (my phenotype) and inventoried my game (genetic and health history) until we knew what the best length and flexibility of the new golf clubs shaft should be, the angle of the housel, the weigh distribution of the club head and grips to fit my touch.
The golf professional said to me, “now that we know how you align your clubs (medication) with your game (ailments), we can fit you properly. We carry ten different models of club with different combinations; the X20 Long has most of the attributes you need.”
I bought a set of clubs, off the shelf that was personalized to me. This company is now engaged in mass customization.
Now, I want to say, tongue in cheek, I have a vision of the golf improvement in the future. It personalized golf. There will emerge a system of electronic golf records. These records will be interoperable between golf courses so no matter where I play, each shot will be tracked. The genetic tendency I seem to have for slicing the ball will be well documented. So, as I need golf clubs in the future, they will be personalized to remedy my ailments.
In fact, because there will be so many golfers like me with electronic golf records, researchers will be able to gather data to invent new tools to cure the common slice and three putt green.
All kidding aside, we do need to begin defining personalized medicine in ways people can understand. We have the technology now to make health care much more personal and much more efficient.
More on this later.
www.hhs.gov/myhealthcare
Lee A.M., Jepson C., Hoffmann E., Epstein L., Hawk L.W., Lerman C. et al. (2007): CYP2B6 Genotype alters abstinence rates in a Bupropion smoking cessation trial. Biological Psychiatry 62: 635–641.
