Comments on: The End of Disease, pt. 1 http://thedecisiontree.com/blog/2007/03/the-future-of-medicine-pt-1/ a blog about predictive medicine and the future of healthcare Wed, 05 Oct 2011 18:14:44 +0000 hourly 1 http://wordpress.org/?v=3.2.1 By: GeneSequenceâ„¢ Blog » The End of Disease, pt. 1 http://thedecisiontree.com/blog/2007/03/the-future-of-medicine-pt-1/comment-page-1/#comment-488 GeneSequenceâ„¢ Blog » The End of Disease, pt. 1 Tue, 28 Aug 2007 15:40:27 +0000 http://epidemix.org/blog/?p=14#comment-488 [...] Recently posted by tgoetz over at Epidemix. [...] [...] Recently posted by tgoetz over at Epidemix. [...]

]]> By: Janie http://thedecisiontree.com/blog/2007/03/the-future-of-medicine-pt-1/comment-page-1/#comment-330 Janie Fri, 08 Jun 2007 18:14:56 +0000 http://epidemix.org/blog/?p=14#comment-330 Many people with lung cancer have a history of smoking, but many smokers never get lung cancer. And many non-smokers do get lung cancer. So clearly, we can’t define disease by etiology, it must be defined by outcome. Although I can see where you are headed with this, it strikes me as tending too far towards the “gattaca” reality than what we really face in the world of health care in the US. Reality tells us that the high numbers of uninsured people in the US don’t have access to preventive care and those that do, don’t access it very frequently. HEDIS data shows that low numbers of insured populations get recommended screenings and treatment, so I’m a bit skeptical that we will start “personalizing” medicine anytime soon. I think we would be lucky to adopt a lower tech system as seen in the UK or Canada, and reduce our mortality and morbidity rates to those of other industrialized nations before we get too carried away with genetic disease profiles. Perhaps you have more of a birds eye view, but I think genetic information may be useful in seeing how different profiles react to different treatments, but I don’t see it as the revolution that we need in healthcare at the moment. It would be a revolution if my friends in their twenties and early thirties would stop calling me to ask where they can get a PAP because they don’t have insurance… Many people with lung cancer have a history of smoking, but many smokers never get lung cancer. And many non-smokers do get lung cancer. So clearly, we can’t define disease by etiology, it must be defined by outcome.

Although I can see where you are headed with this, it strikes me as tending too far towards the “gattaca” reality than what we really face in the world of health care in the US. Reality tells us that the high numbers of uninsured people in the US don’t have access to preventive care and those that do, don’t access it very frequently. HEDIS data shows that low numbers of insured populations get recommended screenings and treatment, so I’m a bit skeptical that we will start “personalizing” medicine anytime soon. I think we would be lucky to adopt a lower tech system as seen in the UK or Canada, and reduce our mortality and morbidity rates to those of other industrialized nations before we get too carried away with genetic disease profiles.

Perhaps you have more of a birds eye view, but I think genetic information may be useful in seeing how different profiles react to different treatments, but I don’t see it as the revolution that we need in healthcare at the moment. It would be a revolution if my friends in their twenties and early thirties would stop calling me to ask where they can get a PAP because they don’t have insurance…

]]> By: Rebecca http://thedecisiontree.com/blog/2007/03/the-future-of-medicine-pt-1/comment-page-1/#comment-244 Rebecca Fri, 01 Jun 2007 21:00:50 +0000 http://epidemix.org/blog/?p=14#comment-244 I'm more interested in what more gene profiling can do for public health initiatives than what it can do for me, personally (good or bad). As you point out - at what point do medicine or public health initiatives intervene? When do the benefits outweigh the risks? How can we create sustainable, affordable public health efforts to identify and mitigate the effects of these fateful factors, or is that even possible with something so (supposedly) personalized as a gene? On the personal level, too, in phase 2 medicine there is already a pervasive lack of patient empowerment in the treatment decision-making process. When faced with genetic evidence for possible future disease states, it seems like it would be harder for individuals to refuse or negotiate treatment - somehow, genes trump all other factors, in spite of the fact that we still understand so little about relationships among genes and between genetics and the environment. For that matter, is our working definition of a gene all that helpful? How will we conceive of illness in this "messy and remarkable future" if etiology replaces outcome as defining the disease state? Oi! I’m more interested in what more gene profiling can do for public health initiatives than what it can do for me, personally (good or bad).

As you point out – at what point do medicine or public health initiatives intervene? When do the benefits outweigh the risks? How can we create sustainable, affordable public health efforts to identify and mitigate the effects of these fateful factors, or is that even possible with something so (supposedly) personalized as a gene?

On the personal level, too, in phase 2 medicine there is already a pervasive lack of patient empowerment in the treatment decision-making process. When faced with genetic evidence for possible future disease states, it seems like it would be harder for individuals to refuse or negotiate treatment – somehow, genes trump all other factors, in spite of the fact that we still understand so little about relationships among genes and between genetics and the environment. For that matter, is our working definition of a gene all that helpful?

How will we conceive of illness in this “messy and remarkable future” if etiology replaces outcome as defining the disease state?

Oi!

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