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Thinking about Life Sciences
http://blog.aesisgroup.com
Tuesday, August 07, 2007
Is Healthcare too Personalized for Personalized Medicine?
The topics in this L ife Sciences D aily blog have been fairly
wide-ranging.
On July 17 , I wrote about the G E-Abbott deal falling through
GE Healthcare acquisition of Abbott
Diagnostics deal scrapped: Who could be the next buyer in line?
suggesting that a lack of synergy betweenthe Abbott Diagnostics
unit (sans Molecular Diagnostics) and GEs Healthcare IT
pharmacogenomics
framework led to a disconnect in agreement over the transaction
price. That posting also proposed theadmittedly radical suggestion
that the vast information carnivore, Google or one of its
affiliates (such as
23andMe.com) could even be considered as a possible acquirer of
Abbott Diagnostics. While I agree thatmay have been a stretch, feel
free to read the posting (or the column in Midwestbusiness.com) to
understand
more of the reasoning behind that.
Personalized Medicine a nd Diagno stic/ T herapeutic
convergence
Back in April, I wrote an article focusing on personalized
medicine Personalized Medicine, TechConvergence Decisive Trends
highlighting how personalized medicine (in operational terms)
implies a
convergence between diagnosis and therapeutics (hence
theranostics) as well as a convergence betweendrugs and devices for
personalized (in the sense of being more precisely localized)
treatment. There is
also the angle to personalized medicine that involves genetic
specificity in treatment - namely the growingarea of
pharmacogenomics.
So whats the connection to Healthcare IT then?
Personalized medicine and IT convergence
Theres indeed another area of technology convergence implied by
personalized medicine. This arises
from the melding of information technology (some call it more
precisely medical informatics) withclinical medicine (whether this
be pharmaceuticals, devices, surgery or a combination). This was
the
underlying message of the Abbott-GE article in July (as well as
its predecessor article in February Whats More Important in
Medicine: Diagnostics, Therapeutics or Prognosis?).
Everyone has been talking about personalized medicine. It is
considered a wave of the future, the holygrail of medicine or
another one of a number of monikers. For a somewhat more prosaic
but hopefully
informative definition of personalized medicine, feel free to
listen to this four minute podcast:Personalized medicine: An Audio
(.mp3) Podcast.
Is H ealthcare is t oo Personalized for Personalized
Medicine?
The irony is that right now one could say that we have medicine
that is too personalized. How could thisbe?
As many know, healthcare delivery in the US is highly
fragmented. If you happen to visit an emergency
room on one day and are unfortunate enough to have to visit
another one on the other side of townanother day, you can be pretty
well sure that neither of them will have access (or even be aware)
of your
respective medical history. Patients have even complained about
this complete lack of information
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interchange between departments in a single hospital. While that
is changing, by and large the availability
of integrated medical records across populations is still a
dream. A notable exception is the VistA(Veterans Health Information
Systems and Technology Architecture) system used by the VA
hospital
system but even that has a ways to go before true seamlessness
can be achieved.
Of course, there are advantages to such a fragmented system.
Privacy is one of them. If you go to a
private doctors office out in Peoria, Illinois and they still
use paper records, it is almost impossible foranyone to know about
it (save a court order and an army of detectives to find it). When
it comes to saving
your life, however, privacy may be a feature that you may
suddenly wish was not there.
The purpose of this brief column is not to debate these privacy
or other politically charged issues. They
are important and there are laws still controversial - like the
Health Insurance Portability andAccountability Act (HIPAA) that
uphold privacy. Other laws such as gun control regulations
actually
seek the opposite such as more openness in records (particularly
psychiatric records).
In this sense, then, healthcare presently is intensely
personalized (in the sense of being fragmented). To
the extent that we do not have an integrated pool of information
across the population, then the trueimplementation of personalized
medicine as defined by the ability to absolutely and accurately
pinpoint an
individual patients optimal medicine and dose, for example for a
particular patient say you isimpossible. Technology convergence
between information technology and clinical medicine is hence
inevitable if the personalized medicine revolution is to really
take off and bear fruit. The reason I write
this now is that just this past week a Reuters report exposed
just how far behind the United States is intrue healthcare
information availability and integration. As the report writes:
the ultimate success of such personalized medicine projects
depends on having thousands of people contribute
health information to be digitally stored a ccording to a sta
ndard format tha t mak es it easy to share.
And continues with a discussion on not just how personalized
medicine becomes a distant dream but also
that high costs and medical errors also raise their ugly
features in the context of an information-sparsemedical system.
Hence, summarizing a report from the Commonwealth Fund:
the U nited Sta tes -- which ha d a k ey role in the creation of
personal computers, the rise of the consumer I nternet,the mapping
of the huma n genome and using technology to cut costs -- lags D
enmark , the N etherlands a nd some other
industria lized na tions when it comes to moving medical records
int o the digital age
So how does the Reuters report conclude?
Is The System is Breaking Down Now?
The last words quoted are from Esther Dyson a director at
23andMe.com the personal genetics site
co-founded by Anne Wojcicki (the wife of the G oogle co-founder
Sergey Brin). Dyson says: The realproblem is that everything
started on paper and it was local and you had one primary doctor.
The system is
breaking down now. Indeed.
My July column proposing that G oogle could be a potential
suitor for Abbott Diagnostics was partly
intended, tongue-in-cheek to raise eyebrows and partly out of
true seriousness.
Perhaps Google (or one of its affiliates) could have no
intention of acquiring Abbott Diagnostics but
technology convergence namely IT and clinical medicine will
happen.
Its only a matter of time.
Ogan Gurel, MD MPhil
[email protected]:/ / blog.aesisgroup.com/
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