Genetic testing is a result of a $30 billion undertaking to sequence the human genome. Using genetic information, “personalized medicine” can predict a person’s chances of contracting diseases. It can also help in tailoring some cures. The tests have until recently been limited to those people who can pay up to $10,000. The tests have recently fallen to about $1,000. Dr. Arthur Caplan, a professor of medical ethics at New York University recently discussed some relevant issues regarding the future of “personalized medicine.”

Q. What’s the difference between medicine as we know it, and “personalized medicine?”

A. Medicine historically has been a one size fits all activity, especially when it came to testing drugs and vaccines. It has to work on everyone because it’s been sold, manufactured and delivered on the basis of “this is going to work for all.” Historically we knew that there were side effects, for example, and those were due to biology but we didn’t have the tools to do anything about it. The current revolution has opened up the door to say, we don’t have to do one size fits all. We can get the drug in the body and have it do what it’s supposed to do.

Q. How likely is it that personalized medicine will deliver on it’s promises?

A. I think it will deliver on it’s promises, but not as fast as some optimists are talking about right now. We’re so eager to make it work. There are some things we can target. We know some people don’t respond well to Coumadin, warfarin, and how to adjust for that. But these are baby steps. There’s going to be a lot more personalized and individualized medicine to come, but it’s like were trying to swallow a giant gush of genetic information and it’s going to take a while to sort it all through.

Q. Having a marker for a disease doesn’t necessarily mean you’ll get it right?

A. Yes. It’s important to remember that testing usually requires counseling. You can be the hairiest guy in the room, have a marker for baldness, and still not be bald. There’s a difference between having the risk and having the disease. There aren’t a lot of counselors out there, and we’ll need more. Most doctors and nurses aren’t trained for this. There’s another challenge with risk information. Genes cause risk, but so do habits. There was a woman who had concerns about breast cancer. She smoked four packs a day. Habits and environment also make a big difference. Just because you have a clean bill of genetic health, doesn’t mean you have no risk factors. Our health is not just in our genes….. Philadelphia Inquirer  3/7/13




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