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Weighing the Cost

By Bill Snyder
January 2010

Will personalized medicine save money?

It depends who you ask.

“I think there’s a big payoff in personalized medicine,” said Harry Jacobson, M.D., vice chancellor of Health Affairs, Emeritus.

Jacobson, a staunch supporter of the university’s investments in the key ingredients of personalized medicine, genetics and informatics, acknowledged that new technology has fueled nearly half of the growth in health care costs over the past 40 years – but that’s because wasteful spending wasn’t cut.

“I’m happy to invest in something that is going to improve my health,” he said. “But I want to stop wasting money on things that add no value to my health.”

“The trick is how you take the dollars out of the complex chain that are not really adding that much value, and put them in areas that really would make a difference,” agreed Dan Masys, M.D., chair of Biomedical Informatics at Vanderbilt.

A better understanding of the genetic underpinnings of drug responses and adverse effects also could speed drug development, Masys said, if pharmaceutical companies knew in advance which individuals were most likely to respond to new medications.

Yes, but abandoning the blockbuster business model for drugs aimed at tiny populations may not cover research and development costs, cautioned nationally known clinical pharmacologist Alastair Wood, M.D., an emeritus professor at Vanderbilt.

“Would the public be willing to accept a model in which smaller numbers of people get treated with a drug but the price was tenfold higher?” Wood asked.

Perhaps as important is whether the public will accept evidence-based medicine, the notion that health care should deliver -- and health insurance should cover -- only what is proven to work.

“In the United Kingdom, and other places soon, payers are starting to say that anyone can have the drug but we’ll only pay for the people it works in,” he said.

Given the current vilification of the insurance industry in the United States, Wood imagines that our response might go something like this: “These people are denying Granny this drug! You must get out immediately and march for this!”

For Ellen Wright Clayton, M.D., J.D, director of the Vanderbilt Center for Biomedical Ethics and Society, patient education and individual rights are equally important challenges to the success of personalized medicine.
Identifying risk factors can give people the information and motivation they need to reduce those risks. But what if they don’t want to see their genetic information? What if they don’t want to make the lifestyle changes necessary to lower their risk?

Can society expect people to do that if they live in crime-ridden neighborhoods with limited resources, and the nearest grocery store with a selection of healthy food is across town?

“I think the challenge for the clinician (will) be to figure out how to use this information in the context of care of the individual and with attention to the individual’s personal desires and social context,” Clayton said. “What I mean by that is, how can you help them use this information in a way that’s actually going to be beneficial to them?”

That’s “going to be more challenging than just getting the doctor the information.”

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