Personalized Medicine Watch

By John Russell

Sept. 23, 2008 | Much has been said about the ability of health-IT to reduce costs, reduce errors, and streamline health care. No doubt this is true and health-IT can cut costs and deliver benefit, though how much remains a matter of debate. My guess is it will be significant. Still, it may turn out that the really big cost (and life) saver is personalized medicine (PM).

Ron Weiss, president of ARUP Laboratories, makes this point elegantly as part of a thoughtful blog in Health Affairs, The Case for Personalized Medicine (http://healthaffairs.org/blog/index.php), in which he broadly surveys challenges and opportunities presented by PM. Consider, these excerpts:

“Every year in the U.S., there are two million serious adverse drug reactions and 100,000 deaths. That makes adverse drug reactions the fourth leading cause of death—ahead of pulmonary disease, diabetes, AIDS, pneumonia, accidents, and automobile deaths, according to the Food and Drug Administration.

“The economic toll exceeds $136 billion per year, greater than the total costs of cardiovascular or diabetic care. In fact, the mean length-of-stay, cost, and mortality for patients with adverse drug reactions are double that of other patients. By identifying which disease pathways respond to which drugs, we can potentially eliminate economic waste at the very time that we improve patient safety...

“One of the best examples is reflected in the fact that even blockbuster drugs provide only limited degree of efficacy in as much as 70 percent of patients. Indeed, the rate of efficacy for standard drug treatment in cancer is only 25 percent, in osteoporosis is 48 percent, and in cardiac arrhythmias is just 60 percent.”

“If we provide patients with more targeted therapy—based upon their genomic profile—that is also guided by diagnostic testing, we have clear potential to improve that impact. The economic savings here are also impressive. The costs to the health care system of ineffective therapy have been estimated to reach as much as $1.2 billion for hypertension medications, $4.7 billion for antidepressants, and $8 billion for statins for cardiovascular..”

This is powerful stuff. Health-IT absolutely can deliver costs savings and streamlining. It will be a necessary and vital element in delivering personalized medicine. But PM on its own may have far greater potential to reduce costs. As Ron suggests, the public discourse around how best to develop, test, and deliver personalized medicine needs to rise.