Medicine today: A battle on two fronts

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Indeed, “disrupt” and “transform” hardly do it justice. Personalized medicine will provide tailored treatment to each individual patient at the right time, and once established, render obsolete the centuries-old diagnostic practice of empirical medicine, which matches a specific disease to a patient’s medical history, symptoms, physical examination, and radiology and laboratory tests to a specific disease, and then offers a treatment designed for the “typical” patient.

Although probably several years away, personalized medicine is coming fast. If it reaches its full potential, I will be out of a job; at least my current job.
But I have growing concerns that personalilzed medicine will not be fully realized.

The Patient Protection and Affordable Care Act (ACA) and its progeny are likely to reduce funding just where it is needed the most: for research on molecular pathways associated with cancer, inflammation, and chronic diseases. These research areas are often not the exciting, romantic fields that attract the most funding, yet their funding is critical.

Worse, the ACA will entomb "the centuries-old diagnostic practice of empirical medicine" (and, unfortunately, an extremely poor version of that) so that personalized medicine is never allowed to fully blossom. It will die on the vine, its full potential left unrealized.

But there is another, almost overwhelming medical issue that screams for our complete attention. Obesity, sedentary behavior, poor diets, inattention to preventable diseases and chronic diseases, and a general social malaise regarding individual responsibility for one's own (and one's children's) physical (and indeed, mental) health threatens to destroy the health of our nation. No doubt this has some origin in society's view of "health" (not just "medical care;" although that is how it is usually expressed) as a “right,” with all the connotations that one has to do nothing in return to receive it. Clearly this has proven over the last two decades to be an increasingly intractable problem. Education alone does not appear to be enough. People generally know very important basic facts: smoking, too much alcohol, lack of exercise, and drugs are bad; and exercise, vegetables, and adequate sleep are good. Yet society's behaviors show no sign of changing. How to prompt societal change is not a question easily answered, yet it is arguably the most important question facing our nation today. More important that debt, or  terrorism, or politics.  Once one’s health is gone, nothing else really matters.

As Dr. Frist says, there is a role for government; however, we are already seeing the pernicious encroachment upon our liberties being instituted by cities in the name of “good health.” The continuing loss of liberties is enough for one to reject these encroachments. But even putting loss of liberty aside, the fact is that the various methods put into place in these cities show little evidence of effectiveness. Indeed, the science they are based on has often proven to be inaccurate. Although it is not often mentioned, the "science" published in the 1970s upon which a lot of “healthy” measures are instituted has been proven false. Many of those studies were not confirmed by further evidence-based, peer-reviewed studies; or contain enough participants to be significant. Many are, in effect, bad science. But today, although modern, well-designed studies show otherwise, we still hear that meat is bad for you, fat is bad for you. At the same time, physical activity for both children and adults becomes scarcer. All this has produced is an obese, unhealthy society.  

Thus, we have today a battle on two fronts in medicine. While they overlap, they also require very different methods to address them. On the personalized medicine front, we need to promote the funding of molecular and genomic research. And, we need to prepare for dramatic, even radical changes in medical care as streamlined, precision medicine delivers on its promises.  

On the societal front, we need to continue to discuss, promote, encourage, and educate. We can lead society to water.  But ultimately, only society can decide for itself when it will drink. But it had better drink soon. Once one's health is threatened, time is short. Once one's health is gone...

Allen is a pulmonary pathologist and Professor and Chair, Department of Pathology, The University of Texas Health Science Center at Tyler.