Precision Medicine: Is It a Must, a Bust—or Something in Between?
Two new articles give completely different perspectives on the value of precision medicine. In the case of myeloma, precision medicine means the development of new, targeted therapy based upon specific gene mutations in the myeloma. A review article in Science lists the “Ten things we have to do to achieve precision medicine” and gives a sense of optimism that, although there are challenges, it is only a matter of time before the advent of precision medicine. An editorial in the New England Journal of Medicine has exactly the opposite perspective! The authors, Drs. Ronald Bayer and Sandro Galea, explain that right now, precision medicine is not what the healthcare system in America needs, and that, in fact, it is a serious distraction from the true needs.
I have to say that I favor this latter viewpoint. Let me explain.
Drs. Bayer and Galea are public-health experts. They are interested in how to keep Americans healthy. For example, they are interested in whether it is better to prevent diabetes or obesity, or wait and just treat them whenever they occur. There is a slowly evolving trend toward prevention as a more effective and cheaper approach. But the public-health infrastructure in the US is terrible, resulting in some of the poorest healthcare outcomes in the world. There is a drastically unequal distribution of resources available to a sizeable population in this country. Many lack access to necessary diagnostics and care, as well as access to programs that keep people healthy! Just waiting and treating is far less cost effective than prevention and early intervention, both of which can really improve outcomes.
If this is starting to sound familiar it is because this is the philosophy of the Black Swan Research Initiative®: look at what is leading to active myeloma and intervene early, BEFORE problems (like CRAB features”) emerge; and develop therapies which are highly effective across the board, encompassing patients with many types of molecular mutations.
Right now—since we do not know about any truly “driving mutations”—it does not make sense to target many, many secondary mutations that develop along the way. Since development of a new drug costs an excess of $100 million and takes 10 years, conservation of resources and retargeting of resources is a better approach.
Thus, although precision medicine is popular and ultimately feasible, the cost-effective approach to myeloma is to intervene early, using broadly effective therapies which can improve outcomes for the most patients.
Clearly, precision medicine is going to be a topic for ongoing debate and interest, so stay tuned!
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