Personalized Medicine Circa 2001
“We have every reason to expect that the revolution in genomics and in brain science will radically change the way we practice medicine. Medicine will be transformed from a population-based to an individual-based medical science; it will become more focused on the individual and his or her predisposition to health and disease.
“Your generation will be the first to reap the benefits of the sequencing of the human genome and use its insights not only to provide better care to patients—better diagnoses, better treatment—but, also, I would hope, more individualized care, more individually tailored diagnoses, and more individualized treatment. Indeed, I would hope that your generation will move us away from the impersonality of managed health care into a new, biologically inspired personalized medicine.
“What reason do we have to believe that this will come to pass? What will we learn from the genome that might orient us more to see the patient as a person rather than as a disease state? The genome of course provides us with a periodic table of life. It contains the complete list and structure of all genes. But it provides us not simply with an average-expectable genome. It provides each of us with our own unique genome. In time, our genome will be a part of our private medical record. As a result, we in academic medicine will collectively have a catalog of all the human genetic variations that account for all the heritable differences between individuals.
“Every disease to which we are prone, including our response to infection, to the consequences of aging, and even our very longevity itself, will be shown to be influenced by polymorphisms in our genes. As a corollary the polymorphisms also will help reveal that complex diseases such as hypertension, depression, and Alzheimer’s disease are likely not to be unitary but to be made up of a number of different, intricately related subtypes, each requiring its own distinctive medical management. What will knowledge of these predispositions and subtypes mean for the practice of clinical medicine? This knowledge will serve to decrease the uncertainty in the management of disease. It is likely that clinical DNA testing—the search for genetic polymorphisms in ourselves and in our patients—will reveal our individual risk for all major diseases and therefore allow us to intervene prophylactically in these diseases through diet, surgery, exercise, or drugs, years before the disease becomes manifest. Indeed, genetic polymorphisms will be found to underlie the way our patients respond to these interventions, so that DNA testing will also allow us to predict individual responses to drugs and to determine the degree to which individuals are susceptible to particular side effects. This will allow the pharmaceutical industry to develop new targets and new tools to sharpen the specificity of the drugs they deliver to meet the needs of the individual patient. This knowledge of the biological uniqueness of our patients will alter all aspects of medicine.
“For middle-aged and older people, you will be able to determine the risk profiles for numerous late-onset diseases; ideally people at risk will know of their risk before the appearance of symptoms, so that their disease might, at least, be partially prevented through medical intervention.”
— Eric Kandel, MD
Columbia University P&S Graduation Address
May 16, 2001