Article

Realizing the promise of personalized medicine.

Genzyme Genetics, Division of Genzyme Corporation, Westborough, Massachusetts, USA.
Harvard business review (Impact Factor: 1.27). 11/2007; 85(10):108-17, 165.
Source: PubMed

ABSTRACT Scientific advances have begun to give doctors the power to customize therapy for individuals. However, adoption of this approach has progressed slowly and unevenly because the trial-and-error treatment model still governs how the health care system develops, regulates, pays for, and delivers therapies. Aspinall, the president of Genzyme Genetics, and Hamermesh, chair of a Harvard Business School initiative to improve leadership in health care organizations, discuss the barriers to personalized medicine and suggest ways to overcome them. The blockbuster model for developing drugs, the authors point out, is still what most major pharmaceutical companies follow, even though its days are numbered. What the industry must embrace in its place is a business model based on a larger portfolio of targeted--and therefore more effective and profitable--treatments, not a limited palette of one-size-fits-all drugs. The current regulatory environment overemphasizes large-scale clinical trials of broad-based therapies. Instead, the focus should be on enrolling subpopulations, based on diagnostic testing, in trials of targeted drug treatments and on monitoring and assessing effectiveness after drugs are approved. A dysfunctional payment system complicates matters by rewarding providers for performance of procedures rather than for accurate diagnosis and effective prevention. Aspinall and Hamermesh call for coordinating regulation and reimbursement so that incentives are provided for the right outcomes. Finally, the authors urge changing physicians' habits through education about genomics, diagnostic testing, and targeted therapies. They say that medical schools and physician organizations must become committed advocates of personalized medicine so that patients and the medical industry can get all the benefits it offers.

1 Follower
 · 
156 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Although several drug dosage algorithms are available, clinicians today still common-ly use the trial and error method in discovering what medicine and in what doses will be most beneficial for each patient. There are currently still very few tools available to help solve these problems, although nowadays there is more and more evidence to show that for a number of drugs, genetic variability plays an important (and some-times central) role in variable response to drugs. This review is focused on the variation within the genes associated with the func-tion of medicines from major pharmaceutical groups of drugs used for the treatment of coronary heart disease (CHD). These include anticoagulants, β-blockers, angi-otensin-converting enzyme (ACE) inhibitors, antiarrhythmics, angiotensin IIreceptor blockers (ARBs), diuretics, and statins. The progress in the field of CHD pharmaco-genomics, which is one of the major focuses in the field of cardiovascular medicine, is ensured by a multitude of studies generating some statistically significant findings that will quite plausibly change the way clinicians treat patients on an individual level. Pharmacogenomic research of cardiovascular medicine in the majority of cases has provided conflicting results thus delaying the implementation of genetic testing to create genotype-based medication dosing algorithms. Nevertheless, analysis of the literature reveals that based on the pharmacogenomic research progress of warfarin and to some extent clopidogrel, the practical use of pharmacogenomics in the future is plausible. Although several drug dosage algorithms are available, cli-nicians today still commonly use the trial-and-error me-thod for discovering what medicine and in what doses will be most beneficial for each patient. Healthcare professionals currently agree that the prime choice for the improvement of this system is to ensure that clinicians are able to pre-scribe medications based on the specific particularities of a patient. This can only be achieved by knowing in advance which medicine will work best for a specific patient (1, 2). It is currently well recognized that there is great interpa-tient variability in response to drugs, including drugs used in the treatment of cardiovascular diseases. There are many factors that can contribute to the way a patient responds to a certain drug, such as race, age, sex, body constitution, nutrition, organ function, diseases, concomitant medica-tions, and genetic factors (3). Therefore, while certain pa-tients may attain the desired therapeutic effect from a given drug, others may not only show no therapeutic benefit, but also experience adverse drug reactions. There are currently still very few tools available to help solve these problems, although nowadays there is more and more evidence be-ing accumulated to show that for a number of drugs, gene-tic variability plays an important (and sometimes central) role in variable response to drugs. The fields of pharmaco-genetics and pharmacogenomics are focused on providing knowledge of the genetic contribution to variable drug re-sponse.
  • 01/2010; 8(2):109-118. DOI:10.1007/BF03320769
  • Source

Preview

Download
2 Downloads