Archive for the 'Personalized Medicine' Category



02
Dec
09

Genetics backlash

Uh-oh. I ran across a couple of articles yesterday that are indicative of what I’d call a backlash about genetics that has cropped up over the last couple of  years. Let’s just say that after the enthusiasm generated by the Human Genome Project and the establishment of a number of personal genomics companies, the bloom is off the rose. After all the high expectations for genomics earlier this decade, there is a lot of disappointment right now.

David Freedman’s article in last month’s Fast Company is titled: “The Gene Bubble: Why We  Still Aren’t Disease Free.” (The term “disease free” in the title perhaps shows how exaggerated the expectations for miracles from genetics have become.) The article describes how biotech companies and investors were ardently hoping that decoding the human genome would lead to specific genetic markers that would provide shortcuts in the process of developing drugs for companies desperately seeking an alternative to the drawn-out, expensive process of testing huge numbers of compounds for drug candidates.

But, Freeman points out, that’s not how things have worked out so far. Only a handful of therapeutics have come forth that can be directly linked to genomic evidence, and many of the companies that were founded on the prospect of genetic paths to products have gone out of business, been bought up, or gone to other approaches. Instead what we’ve found is that virtually all complex diseases have many genetic associations, none of which is a keystone to the illness, and additional complex mechanisms are involved in gene expression.

Freeman quotes Bryan Walser, CEO of gene-discovery company Perlegen Sciences, as he sums up his perspective:

Gattaca got it totally wrong… In the movie, genes have 100% penetration,” meaning that if you have a flawed gene, it’s certain you’ll get the disease it’s associated with. For most major common diseases, he explains, specific genes are almost never associated with more than a 20% to 30% increased chance of getting sick. Indeed, the notion that a small number of genes represents a large component of the risk for a particular disorder has simply turned out to be untrue for almost all major illnesses. And the weakness of these correlations extends to other attributes as well. The gene most strongly linked to intelligence accounts for less than 0.4% of the observed variation, while the top six intelligence genes together predict 1% of the variation. A 2009 study of about 6,000 people came up with a technique for predicting a person’s height by looking at the 54 height-related genes; the results turned out to be one-tenth as accurate as averaging the heights of both parents and adjusting for sex, a technique introduced in 1886 by statistician Sir Francis Galton.

There’s a “we’ve been had” tone to this article, not unlike the backlash against the machinations on Wall Street in the last couple of years. Freeman lays the blame for overselling genetics projects on life science companies that wanted shortcuts to profits paid for by taxpayers and to scientists who wanted to sustain themselves on a pipeline of government research grants. That’s all a bit too conspiratorial for my tastes, and it’s a perspective that comes with the clarity of hindsight. The Human Genome Project and a lot of its proffered benefits also reflect the state of knowledge — or lack thereof — at the time they were proposed. The complexity we now see reflects a lot we’ve learned from tools and techniques of quite recent origin. As has happened a number of times in life science history, we’ve learned that the fundamental processes of life are a lot more complex that we imagined.

More about this matter in the next post.

28
Sep
09

Joining the iPhone throng

When my cell phone contract came up for renewal last July I was able to convince myself that ponying-up for an iPhone and the $30 monthly data plan made sense. Besides keeping up with the cool kids, I think “smart phones” are the next great pulse in digital evolution. Having a gateway in from the internet and out to whatever data stores you want with you 24/7 is a transition that’s as big as the invention of the PC or the internet itself. IMHO the mobile here and now digital interface is the paradigm that will shape us from now on.

So today Apple — without a lot of fanfare — announced the 2 billionth app download from its 85,000 app App Store to the more than 50 million iPhones and iPods out there. Joining the iPhone herd is not a novel move. Moo!

But the function most resonant with my background and interests is the health aspects of real-time mobile connection. The new phone coincides with my own efforts at a little better health behavior. I’ve already downloaded a number of “apps” to see how they can support my program. I’ll be working my way through the mini-programs in the Healthcare and Fitness category and a few from the Medicine category on the App Store. I’ll post more later on how this is working out for me.

25
Sep
09

Patient decision aids

dr-patientHey, I found out about something I hadn’t heard about before: patient decision aids. It appears to be a movement being developed out of Canada (you know, that awful bastion of socialized medicine) with some participation from the US. Anyway, the idea is to provide patients with a body of information about the situation they’ve been diagnosed with and a process for talking it over with their doctor and reaching a mutually satisfactory decision about what to do. In the context of our current debate about health care reform one outcome welcome by about everyone is curtailing over-treatment.

A white paper from Healthwise, a nonprofit that develops the tools, defines a decision aid this way:

Patient decision aids are tools to help people participate with their doctors in key medical decisions. These aids are useful when there is more than one medically reasonable option to diagnose or treat a health problem—particularly when the options have different costs, risks, or benefits that some people might value differently than others.

This is something I want to keep track of. It sounds like a piece of Health 2.0 And it sounds like an attitude of joint participation between patient and provider that most people these days are looking for.

Oh yeah, here’s an example for herniated disc. Ouch!!




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