Doctors Need Help Dealing with Personalized Medicine

Making good health care decisions has always been hard. As informatics teases out patients varied health needs, its poised to get even more complex. And doctor-patient visits are still only 10 minutes long.

Its an open secret that half of people taking certain long-term, high-cost drugs wont benefit from them.

As patients are being asked to shoulder more of the costs, and decisions, for their health care, they face tougher choices about whether the dollars for their daily doses are well spent.

Researchers are starting to figure out which treatments work for which people, but those answers will come as statistics, not certainties.

They promise to cut expensive, unnecessary care, and prevent more-expensive, more-harmful medical injuries.

They will do neither, however, unless doctors are given more training, support tools and time with patients.

Getting the right treatment to the right patient to the right time can save lots of money.

Patient advocacy groups and companies hoping to sell tools to should start lobbying now to get resources to doctors so that they can actually use these tools. More time with patients seems an obvious place to start.

At a conference on personalized medicine this week in San Francisco, Brad Margus, CEO of Perlegen Sciences, described the kind of data that will soon be facing drug regulators and prescribers.

In one example, an effective drug with very unpleasant side effects. (Unfortunately, Margus could not disclose the actual drug or side effects.)

Perlegen found about 20 genetic variants that predict how patients respond to the drug.

Imagine yourself, shivering in your underwear, as your doctor offers this explanation to help you decide whether to take a drug:

If doctors do not prescribe the drug to people with 16 or more of these risky genetic variants, or predisposing alleles, they would exclude 91 percent of patients prone to side effects, but also exclude 40 percent of those likely to benefit without suffering.

Give the drug to everyone with fewer than 21 predisposing alleles, and 97 percent of the patients poised to benefit will get it.

So, too, will 60 percent of the patients bound to suffer. You can call your insurance provider later to figure out how much the treatment will cost.

Granted, many diagnostics will have more clear-cut answers than the above scenario.

Still, both doctors and patients are going to have to deal with more information and ambiguity than theyre used to. Genetic analyses are arguably the furthest along, and few consider effects of age, weight, disease severity and the like.

Of course, patients can educate themselves. One study from University College London indicated that an interactive Web site help patients manage chronic disease.

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