Is Healthcare Too Personalized For Personalized Medicine

Thinking about Life Sciences: Is Healthcare too Personalized for Personal...

1 of 3

http://blog.aesisgroup.com//2007/08/06/is-healthcare-too-personalized-fo...

Thinking about Life Sciences http://blog.aesisgroup.com Tuesday, August 07, 2007 Is Healthcare too Personalized for Personalized Medicine?

The topics in this Life Sciences Daily blog have been fairly wide-ranging. On July 17 , I wrote about the GE-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 between the Abbott Diagnostics unit (sans Molecular Diagnostics) and GE’s Healthcare IT pharmacogenomics framework led to a disconnect in agreement over the transaction price. That posting also proposed the admittedly 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 that may 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 and Diagnostic/Therapeutic convergence Back in April, I wrote an article focusing on personalized medicine “Personalized Medicine, Tech Convergence Decisive Trends” highlighting how personalized medicine (in operational terms) implies a convergence between diagnosis and therapeutics (hence theranostics) as well as a convergence between drugs 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 growing area of pharmacogenomics. So what’s the connection to Healthcare IT then? Personalized medicine and IT convergence There’s 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’) with clinical 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 – “What’s More Important in Medicine: Diagnostics, Therapeutics or Prognosis?”). Everyone has been talking about personalized medicine. It is considered a “wave of the future,” the “holy grail 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 Healthcare is too Personalized for Personalized Medicine? The irony is that right now one could say that we have medicine that is too personalized. How could this be? 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 town another 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

11/17/2008 12:38 AM

Thinking about Life Sciences: Is Healthcare too Personalized for Personal...

2 of 3

http://blog.aesisgroup.com//2007/08/06/is-healthcare-too-personalized-fo...

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 doctor’s office out in Peoria, Illinois and they still use paper records, it is almost impossible for anyone 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 and Accountability 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 true implementation of personalized medicine as defined by the ability to absolutely and accurately pinpoint an individual patient’s optimal medicine and dose, for example for a particular patient – say you – is impossible. 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 in true 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 according to a standard format that makes 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-sparse medical system. Hence, summarizing a report from the Commonwealth Fund: “… the United States -- which had a key role in the creation of personal computers, the rise of the consumer Internet, the mapping of the human genome and using technology to cut costs -- lags Denmark, the Netherlands and some other industrialized nations when it comes to moving medical records into 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 Google co-founder Sergey Brin). Dyson says: “The real problem 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 Google 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. It’s only a matter of time.

Ogan Gurel, MD MPhil [email protected] http://blog.aesisgroup.com/

11/17/2008 12:38 AM

Thinking about Life Sciences: Is Healthcare too Personalized for Personal...

3 of 3

http://blog.aesisgroup.com//2007/08/06/is-healthcare-too-personalized-fo...

Personalized medicine Abbott Diagnostics GE Healthcare technology convergence medical informatics Aesis Research Group Ogan Gurel

11/17/2008 12:38 AM