Personalized medicine is fascinating. A world in which medication and treatments could be optimized based on our genetic makeup rather than the current trial-and-error system could reduce healthcare costs long term. Dr. Eric Topol’s keynote presentation at the Digital Health Innovation Summit emphasized that we need to move beyond the one-size-fits-all approach to healthcare.
Not so fast, said Farzad Mostashari, the former director of the ONC, in a fireside chat with Thomas Goetz, Iodine co-founder and Robert Wood Johnson Foundation entrepreneur-in-residence. Mostashari said he would like to debate Topol on the merits of population health vs. personalized medicine. Mostashari emphasized the need for greater consistency in how we treat people with chronic conditions. “How well are we doing with diabetes? Not so well. Why don’t we do the basic stuff more consistently today?”
It certainly got my attention. I never really thought of population health and personalized medicine as operating at cross purposes. Mostashari later contributed to the Tweet chat with this response.
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Watch this-> http://t.co/2O2dxJMFR2 “@JonahComstock: Did @Farzad_MD just call out @EricTopol on personal vs population medicine? #dhis2013”
— Farzad Mostashari (@Farzad_MD) November 5, 2013
The Medscape interview between Topol and Mostashari clarified the comments a little.
Dr. Topol: There is population health.
Dr. Mostashari: Yes.
Dr. Topol: And then there is what is right for that particular patient-doctor relationship. How do we get that on track?
Dr. Mostashari: I am really glad you brought it up, because there is a tension there between personalized medicine at its best, precision medicine, which we all want to get to. We want to get to a place where there is evidence. And if there is not any evidence, we must learn from every individual healthcare encounter in a way that benefits the world’s knowledge and contributes to the world’s knowledge. Right?
That is how I think of where we are going to be with smart health and where we are today, which is pretty blunt, evidence-based science that says things like “people with diabetes should be taking an aspirin or they should have their Pneumovax® vaccine or be on a statin.” And there is tension between where we want to go and the bluntness of these guidelines.
I get it, but what I think is interesting to observe sometimes is that there is a vast wilderness out here, which is untouched by any science, which is untouched by any evidence, in which variation doesn’t teach us anything. That gets lumped in somehow with precision personalized medicine based on evidence and science, and it is not that.
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I want to see that debate. Is it a matter of priorities? Do we need to pick one or the other? I understand the argument (I think) but I think there’s room for both approaches. Some people just don’t do well on available meds and need a better option. A combination of both strategies might be the real solution.
