Personalized medicine sounds so chic, so sophisticated, so elite. What can be better than having treatment tailor-made just for me!
The problem with a custom product--whether it is a car, a couch, or a chemotherapy regimen--is that the cost of such a product goes up dramatically. And sometimes you don't get what you want. Years ago I knew a woman who had a pair of shoes made by a genuine cobbler. She was living in London at the time and decided, despite the outrageous cost, that this was her one shot at something truly custom-made. The good news was that these were the most comfortable shoes she had ever owned. The bad news is that they were uglier that the north side of a cow headed south, if you know what I mean. The cobbler molded the shoes to her feet; that is why they were comfortable. But she had, in her words, "pork-chop feet" that were, to put it kindly, oddly shaped. The result--weird looking, comfortable, very expensive shoes that sat in the back of the closet, unused.
The CEO of Lilly recently declared that the advent of personalized medicine will usher in a new, more efficient era of drug development. He notes that the typical drug approved by the FDA is only effective in half of the patients who receive the drug. Clearly this is an outrage. Clearly we can do better.
He further argues that personalized medicine will result in lower drug costs. This is where I hit a stumbling block. The process of moving a drug from discovery to market is very, very expensive. To a large extent those expenses are constant, regardless of the sales potential of the drug. Personalized medicine means, in part, that once a drug has gone through this entire outrageously long and expensive process, it will only be prescribed for half the number of patients that might otherwise have received it.
This means that patients will, over the next few years, receive fewer and fewer drugs that have no chance of helping them. This is a wonderful, fantastic development.
What we will all need to watch, though, is the unintended consequence of changing economics in drug development. As the pool of patients decreases, the price point of the drug must increase in order to offset development costs. It is wonderful to think that a cancer patient can eventually receive a drug custom-made for their genetic profile. i can only hope that we can somehow work out the money issues so that drug is, in fact, available and not sitting in the back of the closet like a pair of pork-chop shaped shoes.

