Personalized Medical Treatments

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Two roads diverged in a wood, and I,
I took the one less traveled by,
And that has made all the difference.
                                             —Robert Frost

When Robert Frost wrote "The Road Not Taken" almost a century ago, few choices existed for personal health care. Without antibiotics, an infection took its course. Diabetes was largely untreatable. X-ray images were new. And remedies for many diseases were little changed from the Renaissance.

Virtually no one talked about preventive or predictive medicine beyond mothers insisting that their children down a tablespoon of wretched-tasting cod liver oil.

A century later, physicians have vast arsenals of drugs, procedures, therapies, and data to deploy if one gets sick.

Until now, however, major health-care decisions have tended to be made or guided by doctors. In the coming year, one of the big stories in life sciences will be the explosion of information that will become available to individuals about their current health and what may happen to their health in coming years.

This gives new meaning to Frost's poem about which road we will want to travel as data proliferates about our genes, the impact of the environment on our bodies, and the health and function of our brains.

Integrating all of this—everything from how a person's diet interacts with his or her unique genetic profile to how mercury and other pollutants affect cognitive function in the brain—is in its infancy, but the process will begin to significantly change health care for a growing number of people in 2009 and beyond.

Outgoing Secretary of Health Michael Leavitt recently issued a 300-page report: Personalized Health Care: Pioneers, Partnerships, Progress that offers one of many blueprints that have recently emerged from government and industry that insist the long-awaited era of individualized medicine is on the cusp.

"We are at an early stage in our ability to differentiate between variations in the biology of individual patients and provide effective treatment for different diseases," the report says.

"Even our definitions of diseases remain rooted in 18th- and 19th-century terms. We refer to asthma, but there are many varieties of asthma," Leavitt continues. "From a treatment perspective, they are actually different diseases, yet we are barely at the cusp of being able to identify them accurately and provide the right treatment at the first encounter."

Other proselytizers of individualized health care include Lee Hood of the Institute for Systems Biology in Seattle and George Church of Harvard. They've long called for redirecting medicine and medical research toward personalized medicine to focus on the well rather than the sick. This has begun and will accelerate in 2009.

New online companies—led by 23andme, deCODEme, Navigenics, and DNA Direct—are offering individual customers access to their own genes. Genetic sequencing companies such as Illumina, Affymetrix, and Applied Biosciences are being joined by new firms such as Complete Genomics and Knome to mine individuals' genomes, and are rapidly reducing costs.

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