The growth of personalised medicine threatens the communal approach that has brought our biggest health gains
ADVOCATES of personalised medicine claim that healthcare isn't individualised enough.
Backed up by the glamour of new biotechnologies such as direct-to-consumer genetic testing, personalised medicine what I call "Me Medicine" appears to its advocates as the inevitable and desirable way to go. Barack Obama, when still a US senator, declared that "in no area of research is the promise greater than in personalised medicine".
This trend towards Me Medicine is led by the US, but it is growing across the developed world.
In contrast, "We Medicine" public-health programmes such as flu shots or childhood vaccination is increasingly distrusted and vulnerable to austerity cuts. Yet historically this approach has produced the biggest increase in lifespan. Even today, countries with more social provision of healthcare and less individualistic attitudes have better health outcomes across all social classes.
Contrary to the claims of its proponents, the personalised approach hasn't yet delivered a paradigm shift in medicine. A 2012 Harris poll of 2760 US patients and physicians found that doctors had recommended personal genetic tests for only 4 per cent of patients. The Center for Health Reform & Modernization, run by US healthcare company UnitedHealth, put the figure at just 2 per cent.
But money is still pouring into Me Medicine. In July, the UK government announced that it would offer private companies a subsidy from a 300 million fund to encourage investment in its personalised medicine initiative, Genomics England. Last year the US administration increased the National Institutes of Health budget for personalised medicine, while cutting the budget for the Centers for Disease Control and Prevention's Office of Public Health Genomics by 90 per cent.
Of course it would be nice if we could afford both, but in reality there's a growing risk that "me" will edge out "we". If it does, it won't be because the science is better or the outcomes more beneficial. In some instances of Me Medicine, clinical outcomes are worse than the We equivalent. For example, according to the UK's Royal College of Obstetricians and Gynaecologists, private umbilical cord blood banks, which ostensibly provide a personal "spare parts kit" for the baby, produce poorer outcomes than public cord blood banking.
It is true that in some areas of Me Medicine, such as genetically individualised drug regimes for cancer care (technically known as pharmacogenetics), there has been genuine progress. For example, vemurafenib, a drug for aggressive melanoma, was reported in a 2012 New England Journal of Medicine article to extend the lifespan of 1 in 4 patients by seven months if they carry a specific genetic mutation in their cancer.
But only about half of those with the "right" type of tumour responded, and the mutation in question only occurs in about half of such melanomas. What is more, pharmaceutical firms will probably charge more for such drugs than for mass-market ones. They will be expensive, may benefit only a subset of the population and could leave cash-strapped state healthcare systems facing difficult decisions about where to allocate resources.