[ExI] Article: Realizing the Promise of Personalized Medicine

Max More max at maxmore.com
Wed Dec 5 18:12:30 UTC 2007

I recently wrote this commentary on/review on a 
Harvard Business Review article that will be of interest to many on the list:

Realizing the Promise of Personalized Medicine
Mara G. Aspinall, Richard G. Hamermesh

Thalidomide, a drug sold and prescribed during 
the late 1950s and early 1960s, became perhaps 
the most reviled medical drug ever. Primarily 
prescribed to pregnant women, between 1956 and 
1962, around 1,000 children were born with severe 
malformities to mothers who had taken thalidomide 
during pregnancy. Despite its horrible 
reputation, subsequent research has indicated 
significant potential benefits of the drug as an 
anti-inflammatory that provides relief to leprosy 
sufferers, as a treatment for multiple myeloma, 
and perhaps for arachnoiditis, Crohn’s disease, 
and several cancers. About the only people who 
should not take Thalidomide, it appears, are 
pregnant women. The Thalidomide experience 
underscores the vital importance of carefully 
targeting treatments based on individuals’ 
particular physiologies or­as this article considers­their particular genome.

Not so very long ago in human history, for almost 
all medical conditions and all people, doctors 
would prescribe a course of blood-letting. Now, 
more than ever, doctors are able to customize 
therapy for individuals. Mara Aspinall, the 
president of Genzyme Genetics, and Richard 
Hamermesh, chair of a Harvard Business School 
initiative to improve leadership in health care 
organizations, argue that explain that adoption 
of personalized medicine has been painfully slow, 
being held back by the trial-and-error treatment 
model. That dominant model governs how the health 
care system develops, regulates, pays for, and 
delivers therapies. In this article, they detail 
the four main barriers to personalized medicine 
and suggest ways to overcome them.

If we could accelerate the adoption of 
personalized medicine, we would save both lives 
and money in abundance. Several scientific 
advances seem to make the eventual triumph of 
personalized medicine inevitable. The inevitable 
could be far too slow in arriving since the 
transition from trial-and-error medicine to 
personalized medicine is being held back by four 
barriers: The pharmaceutical industry’s 
historically successful blockbuster model; a 
problematic regulatory environment; a 
dysfunctional payment system; and physician 
behavior that is firmly attached to trial-and-error medicine.

The authors point to several signs that the 
industry’s blockbuster model is failing. They 
recommend that big pharmaceutical companies 
abandon the blockbuster business model in favor 
of one based on a larger portfolio of 
targeted­and therefore more effective and 
profitable­treatments; forge alliances with 
diagnostic companies; and step up efforts to 
communicate the safety and efficacy advantages of 
targeted therapies. They cite several reasons to 
believe that the targeted model would increase 
sales and profits in the intermediate and long 
terms. The current regulatory environment also 
needs overhauling. It overemphasizes large-scale 
clinical trials of broad-based therapies and 
neglects monitoring and assessment after approval 
is won. The authors recommend fast-tracking the 
review of all new drugs that include a diagnostic 
test as part of the patient-selection process and 
urge the FDA to craft appropriate standards to 
ensure the accuracy and integrity of diagnostic tests.

To improve the economics of the payment system 
(which currently rewards physicians for activity 
rather than for early diagnosis and prevention), 
regulation and reimbursement must be coordinated 
to create the right incentives for the right 
outcomes. The authors make some specific 
suggestions for achieving this. Medical schools 
can help overcome the final barrier of physician 
behavior rooted in trial-and-error medicine, such 
as through education about genomics, diagnostic 
testing, and targeted therapies. Employers in the 
United States can do their part to hasten the 
triumph of personalized medicine by pushing 
insurers to cover targeted therapies, including 
diagnostics and insisting that providers 
routinely offer them to their employees; and by 
demanding that cost-conscious insurers focus on 
the overall expense of treatment during the 
entire course of a disease, not just the cost of the initial procedures.

Max More, Ph.D.
Strategic Philosopher
max at maxmore.com 

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