“The medical world is holding its breath, waiting for the revolution. It will be here any minute. Definitely by the end of the decade. Or perhaps it will take a little longer than that, but seriously, it’s right around the corner. More or less.”
So begins Abigail Zuger’s review of three new pop genome books in yesterday’s New York Times. Zuger raises an interesting point about genetic medicine. The panting, bug-eyed enthusiasm for genetic medicine is ever-increasing, uncorrelated with therapeutic advance, and as obscurantist as a political speech. Which, if you believe economics and politics to be different teams playing the same game, it is.
Genetic medicine whips up support not for its results, but for its promise. It sells a vision of a medical future: one in which I will live forever, my doctor will know me personally, medical care will be tailored to me individually, and my diseases will be identified before they start—with treatment begun accordingly.
The promise is not without substance. Science and medical headlines are indeed full of examples of genomic data improving outcomes for one therapy or another and of cases of personalized high-tech medical care. Revolutions are built of many small steps, and it may well be that some time in the future we will understand ourselves sufficiently well at the DNA level to control much illness that currently confounds us and causes suffering. The scientific, mechanistic approach to human health and disease produces astonishing results that are indeed worth celebrating. Medicine is changing. It’s just that, as the doctor said to the achondroplastic dwarf, you’ll just have to be a little patient.
The hype over genomics and personalized medicine has little bearing on the real results coming out of real labs. The glare of the sunny future blasting from the headlines blinds one to the threats lurking in the shadows—the elitism of expensive, high-tech therapies for rare diseases, the risks of side effects from the increasing number of pharmaceuticals we ingest, the prospect of having our health managed from cradle to grave by a privatized, profit-driven medical establishment.
In both these promises and these threats, genomic medicine exposes its roots in biotechnology. In the 1970s and 1980s, recombinant DNA technology transformed biology—but it also transformed the stock market. Investors bought on the rumor and sold on the news, and so rumor became the most valued currency. Today’s genomic medicine grew out of those techniques of manipulating DNA—and it is driven by the same economic forces. The beauty of hype, from an investment standpoint, is that it fans optimism and masks risk. It is a dangerous model for healthcare.
Medical genetics has greatly advanced diagnosis but it has always struggled with therapeutics. Today’s genomic medicine claims to be at last breaking through the therapeutic wall: through understanding the molecular mechanisms of disease, the claim runs, researchers will develop new drugs. Personalized medicine, then, is pharmaceutical medicine. Every drug ever created has side effects, and they tend to be as potent as the main effects. Drug-based medicine treats side effects with more drugs—an antidepressant leads to weight gain, which is treated with an appetite-reducer, which leads to sleeplessness and high blood pressure,… This works out well for the pharmaceutical industry but turns the patient into a passive, chemically managed being. Medicine so dominated by drugs reduces patient autonomy— an ironic and dispiriting side effect of “personalized” medicine.
The books Zuger reviews are contributing to a healthcare bubble. Whatever the benefits that accrue to patients from genomic technology, they cannot possibly live up to the hype.