Shirah Vollmer MD

The Musings of Dr. Vollmer

Precision Medicine

Posted by Dr. Vollmer on March 7, 2016

 

http://newsroom.ucla.edu/stories/daniel-geschwind-to-head-all-precision-medicine-efforts-in-health-system-medical-school

 

It is no longer the question as to how do you treat Type II diabetes, but rather, how to treat Mr. Jones and his diabetes as it may be a different variant from Mr. Smith’s disease. Sounds great, yes? Dan Geschwind, a neurologist, a family member of Norman Geschwind, also a neurologist  https://en.wikipedia.org/wiki/Norman_Geschwind, heads the UCLA Precision Medicine ?Department and I support him fully. With the new technology of genomic mapping, we can now look closely at the genome of cancer cells and infectious agents to determine the specific form of the disease. So, instead of being diagnosed with “ovarian cancer” in the future, which is almost the present, the exact type of cancer will be determined and treated accordingly. You could say that we move from “gross medicine” to “precision medicine”. Well that all sounds good except when it comes to mental health care. You might think that as I promote individualized care with this blog that the idea of precision medicine would give me a sigh of relief, but alas, it does not. The language of today is that “depression is a heterogeneous disease,” to which I say, duh. To map the particular defect which causes human suffering is indeed exciting, but not likely to be clinically useful. Almost thirty years since the birth of Prozac, we, as a field, are finally admitting that our medications are not robust, and in fact, give relief to a relatively small percentage of people (let’s say 60%-for round numbers, with placebo-30%). Now, you might think that would humble us, but no, humility does not seem to be in our culture. It only encourages the search and promise for the “next best thing” which is now genetic sequencing to determine drug metabolism. http://genelex.com/pharmacogenetic-tests/. With new technology comes new business, not necessarily improved patient care. New does not mean better, my marketing friends tell me, but new sounds better and so money is made. Once again, I pursue my rant. Advances in medicine do not necessarily translate to advances in psychiatry, leaving the “old school” listening tool one of the best methods to  alleviate human suffering. I stand by that.

2 Responses to “Precision Medicine”

  1. Shelly said

    With genetic sequencing, I agree with you, it could be harmful to many to find out if they were susceptible to many, many things that they didn’t want to know that they were carriers of diseases of. On the other hand, using gene sequencing and stem cells, you could also find out if your patient could be helped or harmed by a certain medication, without ever testing it on the patient himself. I see there are many cons to the genomic mapping idea, specifically being denied benefits, losing jobs and health care because of ‘what could be,’ but sometimes it could be used to help as well.

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