Personalized medicine: high-tech and low-tech

Though we often think of "personalized medicine" as cutting-edge, technologically advanced medicine tailored to an individual's particular biochemistry, an article in today's Wall Street Journal about the blood-thinning drug Plavix offers an instructive example of how a more expansive conception of personalized medicine is essential to improving patient outcomes.

As the article notes, Plavix tends to be a very effective treatment for the blood clotting that often leads to heart attacks, but it doesn't work for everybody. Roughly 30% of people have a gene variation that limits their body's responsiveness to the drug, hindering its effectiveness. As a result, some people end up taking Plavix without enjoying its salutary benefits. As genetic testing becomes more common and less expensive, it will become easier to identify who these people are and to move them to more effective treatments (or adopt different dosing strategies to overcome the genetic resistance).

But the article also offers a simpler explanation for why patients on Plavix don't always benefit from the drug: they simply forget to take it. Research into patient compliance suggests that "50% of heart patients stop taking important medications within a year of their initial prescription."

Both of these factors--the presence of drug-inhibiting genes and the tendency of patients to stray from their prescribed drug regimens for chronic diseases--can profoundly affect patient outcomes. And though high-tech genetic research has the potential to expand our knowledge of drug effectiveness tremendously, we should not forget that any tool - from a telephone call from a nurse practitioner to an email, or an app on your iPhone - used to improve a particular individual's health constitutes a kind of "personalized medicine."

Simple solutions like reminding patients to take their medicine could ultimately prove just as helpful in saving lives as advanced technology that delves into the complex relationship between genes and drug effectiveness.

Fostering the development of "personalized medicine" therefore does not just mean investing in R&D. It also means creating financial incentives for insurance companies and health care providers to look after their patients' health in more personal ways that are designed to maintain health rather than just to treat illness. The technologically adept among us can also make use of iPhone apps such as "RxmindMe," a free service that alerts individuals when they need to take their prescriptions.

Low-tech forms of personalized medicine are just as crucial as their high-tech counterparts. A full embrace of personalized medicine demands that we appreciate the potential that lies in both.

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