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The Problem With Personalized Medicine

Soulskill posted more than 2 years ago | from the it's-all-so-personal dept.

Medicine 216

gManZboy writes "Talk of individually tailored medical treatment isn't pie in the sky. This approach eventually will help us address risk factors even before a disease can invade our cells, and detect preclinical disease before it gets out of hand. What role will medical informatics play in this brave new world? Hint: Little data projects may be as important as big data projects such as gene sequencing. At a recent symposium on personalized medicine, Ezekiel J. Emanuel, MD, chairman of the Department of Medical Ethics and Health at the University of Pennsylvania, questioned whether it would make more sense to target all the lifestyle mistakes that patients make rather than analyze genetic defects. His view: 'Personalized medicine misses the most important fact about modern society--little ill health and premature death is genetic, much more is lifestyle and social.' Is Emanuel a dinosaur or a pragmatist?"

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There would be no healthcare crisis in the U.S. (1, Insightful)

Anonymous Coward | more than 2 years ago | (#38760880)

if obesity could be rolled back to the levels it had in the 1970s.

 

Re:There would be no healthcare crisis in the U.S. (0, Troll)

Attila Dimedici (1036002) | more than 2 years ago | (#38761030)

That would be true if there was a healthcare crisis in the U.S.

Re:There would be no healthcare crisis in the U.S. (0, Troll)

FooAtWFU (699187) | more than 2 years ago | (#38761134)

Give it another few years for Obamacare to come all the way online, and there may well be. ;)

(oblig. "I'll probably get modded down for this.")

Re:There would be no healthcare crisis in the U.S. (5, Insightful)

Tsingi (870990) | more than 2 years ago | (#38761242)

Give it another few years for Obamacare to come all the way online, and there may well be. ;)

(oblig. "I'll probably get modded down for this.")

Probably. The rest of the modern world all look after the basic medical needs of people, it's pretty much only the US that lets people die because they have no money.

Re:There would be no healthcare crisis in the U.S. (3, Informative)

rizznay (1696094) | more than 2 years ago | (#38761258)

Give it another few years for Obamacare to come all the way online, and there may well be. ;)

(oblig. "I'll probably get modded down for this.")

Probably. The rest of the modern world all look after the basic medical needs of people, it's pretty much only the US that lets people die because they have no money.

I came in to say the same thing Tsingi, there already is a healthcare crisis in the US, and anyone who tells themselves otherwise needs to do some research. The US has been behind in healthcare for years.

Re:There would be no healthcare crisis in the U.S. (0)

rickb928 (945187) | more than 2 years ago | (#38761686)

Pure B.S. Citations, please, beyond anectdotal stories of hospitals violating the law.

Bear in mind that in much of the world people die of disease or injury because they have no access to healthcare at all. Not just no money, but no transportation, no healthcare at all within reach. In the U.S., if you're sick and you can get to a hospital, you will be cared for. And you can probably hitch a ride to the hospital, with the police if no one else. Tell people in most of the underdeveloped world that they aren't denied health care because they have no money. And step back, lest they smack you.

Re:There would be no healthcare crisis in the U.S. (4, Insightful)

aclarke (307017) | more than 2 years ago | (#38761862)

The GGP said "modern world", which you're comparing to the "underdeveloped world". Therefore your response isn't really a fair one.

Maybe the point should be that only in the US do sick people undergo a lifetime of indentured servitude due to medical bills if they can't pay for insurance. In most other places, people don't have to bundle the choice to receive necessary medical care with the aftermath of crushing medical debt payments for the rest of their lives.

And yes, this issue does cause people to avoid the hospital until a little problem has become a big problem, in many cases fatal. Please refer back to Tsingi's "letting people die" comment. No medical system is perfect, but from my vantage point the American system is pretty messed up.

Re:There would be no healthcare crisis in the U.S. (4, Insightful)

ColdWetDog (752185) | more than 2 years ago | (#38762500)

Furthermore, the ER is not the be all and end all of medical care. Treating chronic medical conditions from the ER isn't very useful nor satisfying to either the ER or patient. US FEDERAL LAW STATES ONLY THAT HOSPITALS HAVE TO TREAT PATIENTS FOR EMERGENCY CONDITIONS. Once the "emergency" is over, they don't have to treat you although it is often illegal to just dump a patient out in the street (those tend to be state laws).

And to continue - just because the ER has to treat you doesn't mean the hospital won't bill you. And try to collect on the bill.

So the stupid meme of the US has a health care for all is valid only for a very narrow definition of health care.

And yes, Virginia, there is a crisis in the US healthcare system. Not only do we NOT cover a significant portion of the population, we DO pay more to do so without any measurable benefit whatsoever.

Re:There would be no healthcare crisis in the U.S. (4, Insightful)

Greyfox (87712) | more than 2 years ago | (#38762008)

Anecdotally [go.com] a common [nymag.com] problem.

Funnily how people will rabidly fight to preserve every egg that got a sperm in it, right up until the fetus squirts out of a woman's vagina. At that point it's either completely on its own [wordpress.com] or they actively work to kill it. [pbs.org] Right up until it comes down with a terminal illness and wants some "medical lead" to end its suffering. Then it's back to it being immoral and illegal [go.com] again.

Re:There would be no healthcare crisis in the U.S. (1)

Tsingi (870990) | more than 2 years ago | (#38762176)

Awesome point of view, thanks. It is glaringly hypocritical when you put it that way.

Re:There would be no healthcare crisis in the U.S. (0)

Anonymous Coward | more than 2 years ago | (#38762386)

Okay, you're right. Healthcare in the U.S. is better than in the rest of the underdeveloped world.

Feel better now?

Re:There would be no healthcare crisis in the U.S. (1)

AngryDeuce (2205124) | more than 2 years ago | (#38762640)

In the U.S., if you're sick and you can get to a hospital, you will be cared for.

And that care will be based directly on the patients ability to pay. For instance, it may be in the best interests of the patient to reattach a dismembered finger or toe, but if the patient can't afford the surgery, or if their insurance won't cover it, the finger or toe ain't getting reattached, even though it's in their best interests.

It's easy to say people will get help when it's a life or death emergency because to turn people away for that would be ridiculous and inhumane. But when it's a quality of life issue, it seems that dollars and cents rule the day just as much as they do in any other area.

I saw this myself with my step-sister when she got bladder stones while outside of her coverage area, she had two options, an endoscopic surgery that would have had her home the next day, or a traditional one that would have left her bedridden for weeks (an impossibility; she had a 2 year old at home). The hospital would not perform the endoscopic surgery, period, and advised her to just go home and get it done there. They were kind enough to give her a scrip for pain-killers, though, so there's that, I guess...

Re:There would be no healthcare crisis in the U.S. (1)

rickb928 (945187) | more than 2 years ago | (#38763194)

I'm missing your point. She had options? Why was going home unacceptable?

Re:There would be no healthcare crisis in the U.S. (1)

AlecC (512609) | more than 2 years ago | (#38763238)

While you are correct within limited bounds - the ER will treat people who turn up in an emergency situation, this actually covers a small minority. If you have cancer, you are not an emergency until the cancer is untreatable. If you have Alzheimers, you are not an emergency until you are totally mindless. If you are a diabetic, you are not an emergency until you collapse. What ERs do not provide is palliative and pain relief medicine which can stop people arriving in the ER. So what happens in the US is people are not treated until their condition has worsened so far that they really are an emergency. They are then rushed to the ER, where they are treated extremely expensively, until they are capable of standing upright, and discharged. This is like driving down the road by bouncing off the kerbs: taking no action until the emergency is upon you.

Because people are left untreated until they are in a really bad way, the US actually spends more per capita on "socialized medicine" through Medicare, Medicaid and funding ER than the UK spends on 100% coverage. The mechanisms described above, plus the huge cost of billing, mean that like for like treatments cost about twice as much in the US as they do in Europe. You are spending money to kill your fellow citizens.

Re:There would be no healthcare crisis in the U.S. (1)

celle (906675) | more than 2 years ago | (#38763260)

"In the U.S., if you're sick and you can get to a hospital, you will be cared for. And you can probably hitch a ride to the hospital, with the police if no one else. "

    And sign away their lives while there're at it. You obviously don't know but medical care is prohibitively expensive for people who are living paycheck to paycheck nevermind the ones already in the hole. Thanks to our current plutocracy and the viewpoint of money is life(capitalism) here in the US, no one is going to wreck their financial future to save their life as with no financial future you might as well be dead. So requiring hospitals to help you isn't going mean much if no one is going to come in to become a financial slave for the rest of their life. (redundant but clearer)

    At least other first world countries took away the financial disincentive to get care.

    If wages had kept up with output and if people who did the work actually got paid the true value of that work as opposed to the middle men and upper classes getting it, the capitalistic system might have a chance to work somewhat better but right now at the national level its largely been a failure.(but a great scam)

PS. You want citations, you're on the net, look for them yourself as there's plenty around assuming you're willing to see them.

Re:There would be no healthcare crisis in the U.S. (0)

Anonymous Coward | more than 2 years ago | (#38761762)

Being behind another country in something is not a crisis.

What exactly is the "Healthcare Crisis"?

Re:There would be no healthcare crisis in the U.S. (1)

greap (1925302) | more than 2 years ago | (#38762356)

The US has been behind in healthcare for years.

The metrics that actually matter to the people making use of the system, how more/less likely you are to die of ailment x in country y, shows quite the opposite. If you are diagnosed with any form of Cancer in the US you are more likely to still be alive after 5 years than anywhere else in the world (in some places, such as the UK, the survival rate is half of what it is in the US) and the numbers for almost every other medical problem shows the same pattern with the US being first or top three.

Other metrics such as accessibility the US is a leader in too. Access to doctors is 2nd only to South Korea, wait times for a hip replacement is 1.4% of what it is in the UK and 22% of the OCED average and on and on and on.

The crisis in US healthcare is that people are delusional enough to believe that insurance should cover regular medical expenses, such as doctors visits and the odd prescription drug, and as such pay absurd amounts of money for coverage they don't need; 25 million of us understand this and make a conscious choice to not buy it. If you are under 60 and not chronically ill you can save thousands every year by making use of a HSA & extremely high deductable policy but apparently if you suggest insurance is the problem not the cure you just hate poor people.

Re:There would be no healthcare crisis in the U.S. (3)

ColdWetDog (752185) | more than 2 years ago | (#38762600)

The metrics that actually matter to the people making use of the system, how more/less likely you are to die of ailment x in country y, shows quite the opposite. If you are diagnosed with any form of Cancer in the US you are more likely to still be alive after 5 years than anywhere else in the world (in some places, such as the UK, the survival rate is half of what it is in the US) and the numbers for almost every other medical problem shows the same pattern with the US being first or top three.

Total bullshit. US cancer death rates are in the middle of the pack [nationmaster.com] on aggregate statistics. Yes, the US does pretty good [webmd.com] for some cancers (for some people, most notably those with insurance), but not for all.

Nice of you not to buy insurance when you don't need it. Or don't think you need it. Most people I know don't plan on getting ill. It's not something that is on the calendar for "next year". But keep rolling the dice if you like.

Re:There would be no healthcare crisis in the U.S. (0)

greap (1925302) | more than 2 years ago | (#38762908)

Total bullshit

Here is NiH [nih.gov] on the issue with real data rather then crap from a WHO study based on a few bits of census data like the two links you gave, it shows US as leading the pack.

Perhaps in future check the sources on the crap you link to.

Re:There would be no healthcare crisis in the U.S. (0)

Anonymous Coward | more than 2 years ago | (#38762986)

Give it another few years for Obamacare to come all the way online, and there may well be. ;)

(oblig. "I'll probably get modded down for this.")

Probably. The rest of the modern world all look after the basic medical needs of people, it's pretty much only the US that lets people die because they have no money.

Money has nothing to do with it. It's illegal to deny people health care because they lack insurance in the US, and that's why everyone else's bills are so high. Hospitals have to recoup those costs somehow, and that was the entire aim of the forced insurance Obamacare policies.

What an ignorant statement.

Re:There would be no healthcare crisis in the U.S. (1)

slick7 (1703596) | more than 2 years ago | (#38761576)

That would be true if there was a healthcare crisis in the U.S.

But there is a healthcare crisis, pharmaceutical companies, HMO's and political busybodies keep putting their noses where they don't belong. Healthcare for profit is not healthcare for the individual. The Hippocratic oath says,
"Do No Harm',
however, doctors follow the hypocritic oath that says,
"Do No Harm to the profits of corporate pushers and their questionable (at best) drugs".

Forcing mandatory healthcare down the throats of citizens by politicians who are bought and paid for by Big Pharma, is at best, unconstitutional.
These very same politicians, by the enactment of the National Defense Authorization Act, have declared war on the American population, thereby showing their utter contempt of these very same citizens which, at worst, is treasonous.

Re:There would be no healthcare crisis in the U.S. (1)

hedwards (940851) | more than 2 years ago | (#38762026)

It's not unconstitutional otherwise Medicare would have been thrown out by now. If you don't want the healthcare you have options. I bet you could move to Somalia.

I have a seriously hard time imagining how people could view healthcare as a tool of oppression. Very, very few people opt out in any sort of genuine way now, and under the reform law all you have to do is cop a religious exemption or plead poverty and you're out of it. Doesn't sound very mandatory to me. And even if you don't do that, the fine itself for not having coverage is a lot less than what you would pay for insurance that you aren't going to use.

Re:There would be no healthcare crisis in the U.S. (3, Informative)

tomhudson (43916) | more than 2 years ago | (#38761072)

So ban HFCS (High Fructose Corn Syrup). It's a vicious cycle - HFCS suppresses the hormone that tells you you're full, so you keep on eating more food with HFCS, further suppressing the "Hey Dummy, Stoppppp!" signal.

Pigs eat corn to fatten up. It has the same long-term effects on humans.

Re:There would be no healthcare crisis in the U.S. (4, Interesting)

somersault (912633) | more than 2 years ago | (#38761322)

True, though I don't think it's just that. Any high GI food supplies you energy faster than you can use it. So your body starts storing that excess blood sugar as fat as fast as it can. And then in a little while you're craving energy again, hungry and/or tired. Basically you get sugar withdrawals.

When I tried coming off carbs out of interest, I started in the evening. I felt incredibly tired the next morning. I went out for a walk (probably a mile or two in total) and was really worried I was going to fall asleep on my feet at one point.. but then by the end of the walk I felt good. Basically I think that was because if you exercise for 30 minutes or so you start burning fat for energy rather than relying on stuffing your face. Now I only eat "whole" carbs like brown rice and wholemeal bread/pasta/noodles/whatever. They don't give you the same sugar rushes and cravings that put your body on a chemical rollercoaster.

Re:There would be no healthcare crisis in the U.S. (1)

Tsingi (870990) | more than 2 years ago | (#38761456)

+1 informative

Re:There would be no healthcare crisis in the U.S. (1)

Slime-dogg (120473) | more than 2 years ago | (#38761500)

The high GI foods make you feel fuller, faster. The issue with HFCS is that it does not have a high glycemic index. Thus, you have a large influx of calories, which WILL be put to use by the body. If pop were made with cane sugar, there wouldn't be as bad of a problem.

Re:There would be no healthcare crisis in the U.S. (1)

somersault (912633) | more than 2 years ago | (#38761848)

Well that's interesting about the GI of HFCS, but protein makes you feel much more full compared to carbs, certainly when comparing calorie-for-calorie. And since whole carbs, protein and fat takes longer to digest and absorb than refined carbs, they leave you feeling fuller for longer, without any rapid changes in blood sugar (which results in mood swings.. and more "comfort eating", rinse, repeat..).

Re:There would be no healthcare crisis in the U.S. (1)

mjr167 (2477430) | more than 2 years ago | (#38761878)

You don't have to drink pop. There are plenty of beverage choices that do not involve any form of sugar. We as people decided that we like pop so we drink it and companies cater to our whims. If YOU don't want to drink HFCS, then don't. Don't ask the government to force me to conform to what works for you. If there was one lifestyle and diet that worked for everyone, there would not be thousands of "lose weight fast and stay healthy on this brand sparkly new diet/pill/workout!" products.

My mother-in-law does not eat any carbohydrates and minimizes sugar intake to the point where she knows which vegetables have high sugar. That works for her. My mother tried the no-carb diet for a while and it made her violently ill. There are people capable of eating all day and not gaining an ounce of weight. There is no one-size-fits-all solution, rather general guidelines that appear to work for large sets of people. Each individual has to find a lifestyle that works for them. This is not a place the government needs to intervene by passing sweeping bans of harmless but commonly misused products.

Re:There would be no healthcare crisis in the U.S. (1)

N1AK (864906) | more than 2 years ago | (#38762698)

Don't ask the government to force me to conform to what works for you.

It's government intervention that has put HFCS into so many different products. Corn growing in the US can be done below cost because of government support, this keeps the cost down and that means that it gets stuffed into almost anything. Just about anywhere outside the US the idea of using corn syrup instead of sugar (cane or beat) would be crazy. If the government intervened less in farming then you'd see HFCS (and corn farming in general) decrease considerably in less than 5 years.

Re:There would be no healthcare crisis in the U.S. (2)

sFurbo (1361249) | more than 2 years ago | (#38763042)

The GI of fructose is 19, the GI of glucose is 100. HFCS is about half of each. If I understand GI correctly, HFCS will probably have a GI around the average of the two, around 60. This is right around the 65 of sucrose. While that is lower than the GI for glucose, it seems to be pretty much where sugars end up. Am I missing something?

Re:There would be no healthcare crisis in the U.S. (3, Insightful)

SuricouRaven (1897204) | more than 2 years ago | (#38761442)

Ban? I think just not subsidising it would be a start. The US government spends rather a lot of money paying farmers to grow corn in order to force prices down - and cheap-as-dirt corn is why HFCS is so cheap, and thus so popular in processed foods and snacks.

Re:There would be no healthcare crisis in the U.S. (1)

Dr_Barnowl (709838) | more than 2 years ago | (#38761946)

The flipside is the high import tariff on cane sugar, which has it's roots in politics, and trade protectionism.

It's astounding how politicians go on about the invisible hand of the market solving everything*, and then putting it in handcuffs. Sugar import tariffs being one of those things. If the domestic price of sugar in the USA wasn't double the global price, HFCS wouldn't have ever gained the foothold that it has, and perhaps corn farming might have been replaced by some more productive use of the land (maybe switchgrass or one of the other feedstocks that the biofuel guys say actually provide a decent return).

* note that I am not one of these people, but I am pointing our their hypocrisy.

Re:There would be no healthcare crisis in the U.S. (2)

dpilot (134227) | more than 2 years ago | (#38762736)

Just to throw a little fat into the fire, many of those politicians you mentioned crank about renewable energy subsidies as being "market-distorting", and had them high on the chopping block during budget negotiations. At the same time, we also subsidize the hugely profitable petrochemical industries to the tune of more than an order of magnitude greater. Yet that subsidy is "essential" and apparently not at all market distorting.

Specifically, the numbers I've heard were $13e9 for alternative/renewable energy subsidies and $400e9 for petrochemical subsidies.

Since this thread is also focused on corn, it also says nothing about the ill effects that our "corn manipulations" have had on Mexico. Though I'm sure it's an unintended consequence, first the price of corn dropped so low as to drive Mexican farmers out of business, then it bounced back higher than it was before, after the domestic supply was disrupted. Combine that with the side-effects of the War on Drugs, and the US has really screwed over Mexico. Then those same politicians mentioned above get all self-righteous about illegal immigration.

High Fructose Corn Syrup (0)

Anonymous Coward | more than 2 years ago | (#38762510)

High Fructose Corn Syrup has the same number of calories per gram as any other carbohydrate (including so-called "zero calorie" sweeteners). What differs is the level of sweetness per gram. All sugar interferes with your body's "I'm full" hormone.

HFCS provides a smoothness to drinks which is hard to accomplish with cane or beet sugar.

Re:There would be no healthcare crisis in the U.S. (1)

elucido (870205) | more than 2 years ago | (#38763224)

So ban HFCS (High Fructose Corn Syrup). It's a vicious cycle - HFCS suppresses the hormone that tells you you're full, so you keep on eating more food with HFCS, further suppressing the "Hey Dummy, Stoppppp!" signal.

Pigs eat corn to fatten up. It has the same long-term effects on humans.

A ban on all ingredients associated with and linked to obesity should be law. HFCS isn't the only ingredient that destroys the metabolism. Obesity also isn't the only problem but a ban of HFCS is necessary because it's an unnecessary ingredient unlike salt which we can't live without.

Re:There would be no healthcare crisis in the U.S. (2)

somersault (912633) | more than 2 years ago | (#38761080)

Indeed. Back in the 50s they started telling the world that all fat was unhealthy. People started eating low fat foods, and instead going nuts with sugary drinks/foods, refined carbs and fries. I hate when something says "low fat!" on the front, but it's like 50% sugar. Who cares about the fat content then?

Read up on Ancel [healthimpactnews.com] Keys [proteinpower.com] and the Seven Countries Study if you want to see where the idea that fat is bad came from.

Re:There would be no healthcare crisis in the U.S. (2)

realityimpaired (1668397) | more than 2 years ago | (#38761926)

Indeed. Back in the 50s they started telling the world that all fat was unhealthy. People started eating low fat foods, and instead going nuts with sugary drinks/foods, refined carbs and fries. I hate when something says "low fat!" on the front, but it's like 50% sugar. Who cares about the fat content then?

Yogurt is perhaps the biggest offender on that list. Real natural yogurt usually has a fat content somewhere between 4.5% and 6%. It may be higher, but it is difficult to actually make the yogurt with lower fat content, because it doesn't have the critical mass needed to thicken into something you can eat with a spoon. When you see a yogurt with 2% or lower fat, it's thickened by adding corn starch after the fermentation is completed.

And as others have pointed out, the corn starch and related sugars don't trigger the "I'm full" feeling, so not only are you consuming more calories, you're consuming calories that your body won't recognize as having been consumed... it's less filling and higher calorie density. :(

Just don't get me started on aspartame.

Re:There would be no healthcare crisis in the U.S. (0)

somersault (912633) | more than 2 years ago | (#38762678)

Yeah aspartame is crazy.

For those who love diet drinks:

Nutrasweet (aspartame) is an artificial sweetener added to over 9,000 products worldwide. [...] Originally classified by the US Food and Drug Administration (FDA) as a neurotoxin (nerve agent), this chemical was developed as a chemical warfare weapon.

There's a saying for that: (2)

Hartree (191324) | more than 2 years ago | (#38761170)

"If a frog had shock absorbers, it wouldn't bump its butt when it hopped."

Easy to say. It's proved more difficult to actually get people to lose weight.

Re:There's a saying for that: (0)

Anonymous Coward | more than 2 years ago | (#38761564)

Somewhat off topic, but you know what really motivates you to lose weight.. heart problems.

Seriously.. Used to be pushing 260lbs.. started having issues with my heart (which incidently turned out to have nothing to do with the weight or anything I could have really controlled) which scared the shit out of me and I lost that weight in a damn hurry (well, as hurried as was safe according to my doctor).

Re:There's a saying for that: (2)

Hartree (191324) | more than 2 years ago | (#38761844)

Lets distill it down even more. Fear is often what motivates.

Not surprising. That's how we evolved. Fear kicks in and we move.

But, as I mentioned in another post, slowly changing things like weight and lifestyle don't raise fear in and of themselves.

Regardless of how much it makes sense, you have to find a way of getting people to actually go along with the lifestyle changes. And that's not always easy to do in a way they won't consciously or subconsciously rebel against.

Having everyone get diagnosed with life threatening very scary illness probably isn't the way to change behavior. It might well work, but it has downsides.

Having people in a controlled military like environment WRT eating and exercise, for example, might well work wonders for their physical health. But it's neither something most would opt for, or really a reasonable option.

I'm certainly implying "just give up". I'm just saying that our usual social control mechanisms which are little changed from say, the Roman Empire, haven't been as effective with this as they are for some other things. I'd love some new ideas.

Re:There's a saying for that: (1)

Hartree (191324) | more than 2 years ago | (#38761868)

Should be "certainly not implying".

Gah, mornings.

Because we'd all live forever? (5, Interesting)

overshoot (39700) | more than 2 years ago | (#38761266)

There are two parts to the "healthcare crisis" in the USA:
1) People who can't afford it and therefore suffer. This includes accidents, communicable diseases, etc. that aren't much dependent on obesity.
2) Huge amounts of resources spent (about half of all healthcare spending) on dragging out the process of dying for people who are, one way or another, going to die soon anyway. Most of them are geriatric patients with incurable progressive conditions: metastatic cancer, congestive heart disease, Alzheimer's, etc.

Better lifestyle practices will give us longer, healthier, and for many of us happier lives. They won't make us invulnerable nor immortal. They won't keep our families from bankrupting themseves trying to add one more week of misery in ICU when our time comes.

Re:Because we'd all live forever? (0, Insightful)

Anonymous Coward | more than 2 years ago | (#38761346)

We are all, one way or another, going to die soon anyway. Many of us are born with incurable progressive ageing and may be prone to cancer, heart disease, Alzheimer's, etc.

Some people want to stay alive for longer than you might want them to. One day, you might be fighting to stay alive too (or maybe you don't think so - but maybe you'll change your mind in 50 years' time). It's not as if something better is waiting for them.

The healthcare crisis in the US is the same as all crises: the introduction of profit motive. Whether that's through the privileges of nomenklatura or shares in US health insurance, it always goes wrong in the long run.

I doubt it (2)

overshoot (39700) | more than 2 years ago | (#38761810)

One day, you might be fighting to stay alive too (or maybe you don't think so - but maybe you'll change your mind in 50 years' time).

If I'm still alive at 110, I doubt very much that I'll be all that stressed out about checking out. Plenty of family members have gone peacefully when they got tired of living -- including my maternal (step-)grandmother who basically just withdrew until she shut down and my paternal (step-)grandmother who lived to 97 and got tired of burying children and grandchildren. I think my mother is headed that way soon.

So be it. Give me a good view out over the Rio Grande and some (great-)grandchildren in the house. It's been a blast so far and the rest is gravy.

Re:Because we'd all live forever? (4, Insightful)

InsertCleverUsername (950130) | more than 2 years ago | (#38761658)

2) Huge amounts of resources spent (about half of all healthcare spending) on dragging out the process of dying for people who are, one way or another, going to die soon anyway. Most of them are geriatric patients with incurable progressive conditions: metastatic cancer, congestive heart disease, Alzheimer's, etc.

Better lifestyle practices will give us longer, healthier, and for many of us happier lives. They won't make us invulnerable nor immortal. They won't keep our families from bankrupting themseves trying to add one more week of misery in ICU when our time comes.

Precisely. The biggest reason we spend twice as much [reuters.com] as other countries on healthcare, yet find ourselves in the company of some third-world countries in outcomes, is that we blow horrible amounts of cash on unnecessary (read CYA for lawsuits) tests and ignorant "futile care" that tortures the dying in order to extend their lives a few months. More here: http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/ [zocalopublicsquare.org]

Re:Because we'd all live forever? (1)

Qzukk (229616) | more than 2 years ago | (#38761948)

we blow horrible amounts of cash on unnecessary (read CYA for lawsuits) tests

And in Texas, we got tort reform and discovered what's really going on is that "we blow horrible amounts of cash on unnecessary (read doctor gets paid per test) tests" http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande [newyorker.com]

Re:Because we'd all live forever? (0)

Anonymous Coward | more than 2 years ago | (#38762650)

"Better lifestyle practices will give us longer, healthier, and for many of us happier lives. They won't make us invulnerable nor immortal. They won't keep our families from bankrupting themseves trying to add one more week of misery in ICU when our time comes."

Wow, you're absolutely terrible if you think this is a bad thing.

Re:Because we'd all live forever? (0)

Anonymous Coward | more than 2 years ago | (#38762742)

I agree with you but it is easier said than done. Would you go and justify not spending on people who have a progressive disease to their family members? Even bringing issues like this in front of the people stirs up an ethical drama. One big thing that can be done is tort reform and hence avoiding the frivolous lawsuits that are making the lawyers file class action at the drop of a hat.

Not true (4, Insightful)

rsilvergun (571051) | more than 2 years ago | (#38761306)

the 'healthcare crisis' is because the nature of healthcare changed and the delivery mechanism did not. In the 1970s, healthcare was very limited. A doctor could set a bone, stitch you up, and blast you with radiation hoping for the best. In 40 years we've moved to things like personalized medicine (where for the price of $10,000 a month an aids patient [damonvickers.com] can thrive, plus a raft of preventative medicines and maintenance medicines. Do you see the shift? We've gone from caring for a few major disasters and making you comfy when you die to maintaining the human body like you would any other machine.

An insurance model for delivering healthcare works for disasters and a one time end of life expense. It breaks when you're using healthcare for maintenance. The thing anyone without socialized medicine is, unless you're so rich you can drop $10k/mo, you don't really have healthcare. Because as soon as you need it, I'm mean you're really going to use it and use it regularly, your insurance provider is going to take it away. That's why America socialized medicine... for the elderly. But even they're going to lose it soon. Just you wait. You think it's there, but it's not. And by the time you realize it, it'll be too late. Poverty will crush you and you won't matter any more. You'll just fall by the way side.

Re:Not true (0)

Anonymous Coward | more than 2 years ago | (#38762658)

Warning: Parent is a link farmer.

Leverage the internet and patient self interest. (1)

elucido (870205) | more than 2 years ago | (#38763400)

On one level the patient has to take more responsibility for their health but on the other level the patient should be as well informed as their doctor. There used to be a time where you had to go to medical school to learn certain things. On some level that is still the case. Get rid of the paywalls for medical journals so that patients can keep up with the latest research.

Allow patients to be diagnosed through the internet through remote terminals if necessary. The technology will eventually exist to detect metabolic syndrome using light sensors. The technology will eventually exist to detect blood sugar levels using the same means or through breath. Blood pressure could be remotely determined as well. Remote monitoring will be the major advance.

Don't get me wrong medicine will always be expensive and it probably should be, but it doesn't have to be as expensive as it is. First there aren't nearly enough doctors. Second the cost of medicine is way more expensive than it has to be. Third there isn't enough focus on prevention or preventative care.

Personalized medicine might tell a doctor what sort of preventative care program to put a patient on but it wont necessarily prevent anything if the environment is continuously polluted to the point where the patient gets sick regardless of lifestyle. The asthma epidemic is environmental not lifestyle. Children are developing obesity so it's not lifestyle anymore. What are we going to do? Wait until children are dying of heart attacks and cancer before we figure it out?

Re:There would be no healthcare crisis in the U.S. (1)

fish_in_the_c (577259) | more than 2 years ago | (#38761494)

and the average age could be rolled back as well. Much of the 'crisis' is due to a much older population needing more help to stay healthy.
An effect of the legalization of contraception.

Re:There would be no healthcare crisis in the U.S. (1)

hedwards (940851) | more than 2 years ago | (#38761976)

Not likely. It would probably mean that we'd be spending those dollars on other health care services. The reason why health care is so expensive in the US comes down to a few things. One, for profit entities in the system, that profit does jack shit for patients that can't afford coverage because it's expensive. Two the fact that you could get sick and then have your insurance dropped over a technicality or not renewed. Third the lack of preventative care that has been endemic in the system over the decades.

Re:There would be no healthcare crisis in the U.S. (0)

Anonymous Coward | more than 2 years ago | (#38762078)

I wish women would look like in the 1970s... Like Jungle Pam.

Ban ingredients like HFCS (1)

elucido (870205) | more than 2 years ago | (#38763196)

If obesity is such a concern the political solution is the best solution to cut healthcare costs.

Start by banning HFCS on the federal level and all chemicals like it. Just like asbestos had to be banned, HFCS has to be banned. Pollutants have to be regulated as these environmental factors affect the metabolism as well. Pollution in the plastic containers for example.

After the unhealthy ingredients such as HFCS and transfats are banned then we can logically tackle the obesity problem. Until that point we cannot take any initiative to combat obsesity seriously.

Excuses sell better than solutions (2, Insightful)

Anonymous Coward | more than 2 years ago | (#38761016)

Everybody knows this, but medicine is a business first. Excuses sell better than solutions. End of story.

Sane (1)

stanlyb (1839382) | more than 2 years ago | (#38761018)

He is just a sane and honest man. It is no coincidence that in some areas live people more than 100 years without any medical treatment, and snacks, and chips, and coke, and GMO (as a matter of fact), and ......i arrested my case.

Re:Sane (0)

Anonymous Coward | more than 2 years ago | (#38761204)

Ancient chinese secret: selective breeding is just GMO with less variables.

Re:Sane (1)

tepples (727027) | more than 2 years ago | (#38761830)

And according to opponents of recombinant GMO, those more variables are what pose the threat to a nation's food supply.

Data-driven loop closure is the holy grail (1)

taliesinangelus (655700) | more than 2 years ago | (#38761026)

Through initiatives like NEMSIS (www.nemsis.org) and marrying that data with ER/hospital data, the loop closes for providers in the continuum of care. The data can drive performance improvement for each step in that continuum of care as hospitals have never been so informed about what happened on an EMS call and vice versa. This directly improves patient care on an individual level and on progressively higher levels. Several states are doing this with data with the leader being North Carolina.

The preclinical diagnostic power suck (1)

G3ckoG33k (647276) | more than 2 years ago | (#38761052)

The preclinical diagnostic power suck.

That is why this is not a good route.

Diagnostics even in the clinical stage is not often very well founded, unless you have a broken leg or something to that effect. Psychological disorders are really, really difficult to diagnose with decent accuracy, and therefore should never be treated a preclinical stage.

A can of worms or a jar of pills?

Pragmatic, Somewhat. Maybe: (1)

Hartree (191324) | more than 2 years ago | (#38761062)

Part of the question is CAN it really be effectively changed by lifestyle changes over a whole population?

It's easy to say "eat less fat, and fewer calories and it will be better". We hear that all the time. Exercise more. No alcohol to excess.

But, actually getting people to follow it in a sustainable way hasn't happened in many cases.

When you have a method that well work, but you can't get people to follow, it's not very effective.

In some cases, drug interventions are more likely to be followed. Take a look at cholesterol meds (I live on em.). You can get people to take a pill a day more easily than giving up the cheeseburgers.

Maybe it should be that they change their lifestyles, but that's not the way it happens much of the time.

Another area which personalized med will help greatly is choosing which medication to use. Many times treating chronic illnesses requires switching drugs several times to find the ones that work best with fewest side effects. Having testing to identify how your body will react to a given medication would be very helpful.

Re:Pragmatic, Somewhat. Maybe: (1)

stanlyb (1839382) | more than 2 years ago | (#38761182)

Have you seen any FAT lion??? I wonder why not!!!

Re:Pragmatic, Somewhat. Maybe: (1)

Hartree (191324) | more than 2 years ago | (#38761280)

Because though there is an illusion of freedom in the wild, lions are strictyly hemmed in by mother nature in terms of calories.

They have to compete with other predators whose territories surround theirs and the reality that they can only harvest so much food and not deplete their territory. That's why there hasn't evolved such a strong ability to limit intake. It's mandated by the physical environment in animal societies.

Do you really want a society where caloric intake is strictly regulated by physics (or humorless people assigned to snooping on everything you eat/do)?

Re:Pragmatic, Somewhat. Maybe: (0)

Anonymous Coward | more than 2 years ago | (#38761506)

I think that you answered the question in your response: of course he's being pragmatic.

Doctors can look at your lifestyle choices and let you (and other doctors) know why you are dying faster than you think you should. Perhaps they will have treatments to help slow your own self-destruction, maybe they won't, but at least it won't be a secret to anyone why your health is in rapid decline. And this is especially nice for medicine as a science because adopting this method of diagnosis coupled with open information sharing (if that existed) could allow large scale data modeling to better show correlation and causation as people continue to chose cheeseburgers over the possibility of more time with their loved ones. Doctors aren't your parents or god or something, they can't make you stop killing yourself, they can just tell you that you are and try to develop ways to slow it down or make it more comfortable.

Not only is it a wonderfully pragmatic view, but it's a win win situation for medical science.

Re:Pragmatic, Somewhat. Maybe: (1)

RicktheBrick (588466) | more than 2 years ago | (#38761788)

Last year I was told that I should have my gallbladder taken out. Instead I changed by diet. I became a full vegetarian and use olive oil instead of vegetable oil and olives instead of fish. I eat a lot more raw fruits and vegetables now and I still have my gallbladder.

Re:Pragmatic, Somewhat. Maybe: (1)

Hartree (191324) | more than 2 years ago | (#38762062)

Indeed. It worked. What worked was one of the most effective ways of changing behavior there is. Fear.

But, as I mentioned in another post, just relying on fear is limited. We've been getting out the word on obesity for decades. But, it's not producing fear in sufficient amounts to broadly change behavior. Our minds adapt to the situation, and we have an amazing ability to rationalize. Those traits served well in an animal environment where calories were limited by the environment. If there was excess food, the population rose to meet it. Or another species increased.

Now we have a situation where society/indvidual controls aren't working as well as they have in the past due to it being a different situation (whether it's HCFS or food immediately available on impulse, etc, etc take your pick of whatever cause you favor. I suspect it's not just one.).

The methods we have been using aren't working so well. Or at least, the social costs of imposing those methods in a way strong enough to work are awfully high.

Go get Ayds and live (1)

tepples (727027) | more than 2 years ago | (#38761908)

You can get people to take a pill a day more easily than giving up the cheeseburgers.

Then why not bring back Ayds? Unlike AIDS, Ayds was a safe and effective appetite suppressant candy that one would eat before a meal to decrease one's desire to "has cheezburger".

Re:Go get Ayds and live (1)

geminidomino (614729) | more than 2 years ago | (#38763264)

If it worked that well, it's hard to believe they deep-sixed the product rather than just change to a new name (Gee, going from "Ayds" to "Diet Ayds" didn't break the memetic connection to AIDS? SHOCKER!).

Even if they follow it, it wont matter. (1)

elucido (870205) | more than 2 years ago | (#38763456)

Their air will still be toxic. Their water will still be polluted. Their food will still be processed with chemicals.

What do you expect? No amount of lifestyle change can protect you from every possible form of pollution in the environment.

Well... (2)

fuzzyfuzzyfungus (1223518) | more than 2 years ago | (#38761090)

Arguably, targeting things like lifestyle factors is also "personalized medicine", in the sense that treating patient X specially because a defect in their homozygous foo allele predisposes them to cardiac disease isn't all that different from treating patient X specially because getting no exercise predisposes them to cardiac disease.(and, in uncomfortably-many-but-not-all cases, the "personal" element is just the most visible factor in a stew that includes environmental and social influences, like diesel soot and cube farms...)

I'd be inclined to say that Emanuel is neither a dinosaur(he isn't rejecting the new-and-shiny out of hand, just pointing out that much of it offers questionable bang-for-buck compared to the low hanging fruit offered by seriously boring lifestyle stuff), nor a pragmatist(y'know why people like to ignore lifestyle factors and focus on genetic whiz-bangs and hypothetical personalized super-pills? Because lifestyle intervention lies dead at the center of the intersection of "really boring", "really hard", and "lousy patient compliance".

We already have plenty of good advice to go around(by no means perfect knowledge; but we know much better than we do), largely unheeded and often coexisting with social conditions that actively work against heeding it. We don't actually have personalized genetic-super-pills(with limited but important exceptions: oncology, for instance, has a number of genetic markers that have proved tractable to test for and highly useful to know. Some rare hereditary disorders have also been well worked up. Much of the rest of it remains in the "yeah, it sure does appear to run in families; and we made this mouse model by tweaking the genes like so; but that doesn't help you very much...); but we could probably get people to take them fairly regularly if we did...

The use (2)

fish_in_the_c (577259) | more than 2 years ago | (#38761120)

One of the things 'personalized' medicine addresses is the 'well that's not me' factor that is in may people mind.
The reality is that a percentage of people in the population will never need to worry about cholesterol problems and the knowledge that such people exist allow others to live in the illusion that they may not have to worry about it either.
Personalized medicine will allow the Dr, to tell a person YOU need to not 'X' or you will have 'Y' happen.

The problem however is that it is always a percentage game. Some of the genes we have found so far increase a persons chances of developing a certain type of cancer by 1 or 2 %. So is that enough to warrant changers in behavior.

People who work in computers for a living already know that their carrier choice raises their cancer risk by something like 20% ( how many of them left their careers because of it though).

Part of the problem is understanding the risk ... and them excepting the consequences if they show up.
( are we allowed to do that anymore !!)

Re:The use (0)

Anonymous Coward | more than 2 years ago | (#38761556)

Bad spelling aside, this is a bigger problem in socialized medicine. If the government pays everyone's medical bills, then the government has an incentive to keep people healthy, and the best way to do that is through force. If you want someone to take responsibility, then you need to educate them - your family is predisposed to heart attacks so if you keep eating at McDonalds, you may need to pay for the following operations in the future at a cost of X. As long as a patient is aware of their own situation and understands the potential costs to them in terms of money, quality of life, or time, then you can't do much more.

Re:The use (0)

Anonymous Coward | more than 2 years ago | (#38763180)

"People who work in computers for a living already know that their carrier choice raises their cancer risk by something like 20%"

Can you substantiate this claim?

Practical advice is not what people want (5, Insightful)

Anonymous Coward | more than 2 years ago | (#38761148)

Emanuel is right, but experience tells us that people don't want straight-forward advice about not eating deep-fried butter or exercising more. They want to do it anyways and be saved by medicine when it catches up to them.

Pragmatically speaking (1)

overshoot (39700) | more than 2 years ago | (#38761168)

He's right, it would be vastly more effective (not to mention cost-effective) to address the lifestyle risks.

Now: for a quick assessment of his chances: how many of us are sitting around on our butts reading /. instead of getting some exercise?

Yeah, I thought so. Maybe the genetic screening is worth doing after all.

Re:Pragmatically speaking (1)

Hartree (191324) | more than 2 years ago | (#38761332)

Bingo. I already commented or you'd get modded up.

missed it by a mile (0)

Anonymous Coward | more than 2 years ago | (#38761178)

You're coming at this from the typical leftist viewpoint of desiring to control everyone's lifestyles and choices, but that's not what personalized medicine is about. It's about figuring out what medicines you'll respond to the best, based on your genetics.

From your progressive, utopian angle you could also view it as avoiding administering expensive treatments that won't do much good for that patient, and thereby reducing total healthcare costs to the system. But the term is not about molding a more perfect society through more socially-correct behaving citizens. There are other words for that.

Human Nature (1)

gutnor (872759) | more than 2 years ago | (#38761216)

It is easier to "sell" (as in commercial, or even simply convincing) some treatment against a silent potential killer in your gene, than asking you to change your habit (stop smoking, drink less, ...) for an actual killer in your lifestyle. Same thing happen for about anything: people are scared of terrorists, but do not driving or even go boozing in high criminality area.

People do not give a shit when they are in charge, so in practice, short of making lifestyle change mandatory by law, you can only really work on the genetic defect. (smoking has 30% to kill you in the next 10 years - does not give a shit. A gene in your DNA give you 10% higher probability to have a heart attack before you are 70 - oh my god, I'm doomed - what can I do doctor)

Personalized medicine = "the cloud" (1)

neurogeneticist (1631367) | more than 2 years ago | (#38761220)

The term "personalized medicine" is a buzzword. We've been targeting specific environmental things in specific people for a long time now. It turns out it is hard to get people to get in shape, control their blood pressure, and quit their bad habits. Genetics is as personal as it gets, so that has become the new holy grail. Genetics offers the ability to identify new risk factors and improve understanding of the underlying disease. Many of the identified common and even rare variants in disease don't lead to therapies, but they do tell us about the pathobiology, which may in turn lead to new discoveries and/or therapies. We would love to study gene-environment interactions, but there are major power issues when trying to do studies like this in sporadic, complex disease like heart disease, hypertension, stroke, and the like. We're still trying to develop large enough sample databases and robust analytic techniques that allow us to study the interplay between millions of genetic variants and the often difficult to quantify or report environmental exposures that may act in concert in additive or even multiplicative ways.

Re:Personalized medicine = "the cloud" (1)

cryptolemur (1247988) | more than 2 years ago | (#38761504)

It's not a buzzword, nor is it a holy grail.

It's just figuring out (fast) what treatment is the best for a specific individual with a specific condition.

For example, you take a sample of a persons tumor, and in a lab attack it simultanously with over 200 different treatment combinations. Find the most effective combination and report it to the doctor of the patient. Very likely the same cocktail of medication won't work (as efectively) on any other patient.
On a more general level, there are treatments that are completely uneffective when patient has certain genotype, so checking for that before starting the treatment would be smart move, too. Or the other way around, the treatment is effective only with certain genotype.

We don't need to know "why", we only need to couple a patient with treatment that works. We don't need large datasets, we need individual, or personalized, medication.

He's from UPENN, right? (0)

Anonymous Coward | more than 2 years ago | (#38761224)

First off, this guy probably isn't some quack. UPENN is pretty hardcore about medicine. Second, part of me (the cynical part) wonders if this isn't partially because UPENN is in Philadelphia and Philadelphians (myself being one of them) aren't the healthiest people in the world. Lot's of smokers, an above-average overall occurrence of obesity... Could just be jaded.

Still, I'm inclined to agree. Unless we're talking about most cancers (which genes definitely have a lot to do with) lifestyle does have a major impact on your health and a lot of people like to ignore that.

Orwellian Phrase (1)

Sponge Bath (413667) | more than 2 years ago | (#38761246)

...targeting lifestyle "mistakes"

Doesn't that sound like a conveniently vague catch all for justifying corporate or governmental control over people?

Re:Orwellian Phrase (1)

BlueStrat (756137) | more than 2 years ago | (#38762086)

...targeting lifestyle "mistakes"

Doesn't that sound like a conveniently vague catch all for justifying corporate or governmental control over people?

I'm sorry Citizen, but your statement fails to inspire happy-happy, joy-joy feelings in everyone around you.

Please remain at your present location and await a Protect-Serve patrol that will assist you by transporting you to the nearest Community Adjustment Center to modify your outlook and behavior so as to inspire happy-happy, joy-joy thoughts in yourself and those around you.

Failure to comply may result in a minimum 70 year stay at the nearest cryo-prison facility where you will be subliminally re-educated while in stasis to help you extract maximum self-joy by being an asset to proper, civilized society.

Be Well and Consume.

What Personalized Medicine Is For (5, Insightful)

Samantha Wright (1324923) | more than 2 years ago | (#38761290)

...Emanuel seems to be missing it by a mile.

This field is for dealing with the little ugly gaps that neither broad pharmacology nor lifestyle adjustment can correct. Take the case of antidepressants, for example: they're extremely finicky (not all work in all people) and have a huge cost in side-effects before the benefits arise. It is an extremely high cost to both the patient's health and the support system to cope with a bad choice of antidepressant. The basis of this fickleness is genetic, and running the right test in advance can prevent bad combinations.

Personalized medicine is not a cure-all, it's a very precise tool in drug design and selection. I'm sure that won't stop lazy physicians and marketers from calling the regular diagnostic process "personalized," though.

Re:What Personalized Medicine Is For (0)

Anonymous Coward | more than 2 years ago | (#38761836)

You are making very broad assumptions there.

Firstly, antidepressant choice is most influenced currently by overdose risk (TCAs more effective but potentially fatal, SSRI/SNRI much higher margin of safety). The overwhelming complexity of not only the effect of the drug, but the side effects, interactions, and stuff that gets blamed on it for no good reason ("I remember last time I had paracetamol I had a headache. Paracetamol therefore gives me headaches. I'm allergic to it.") means that genetic profiling is unlikely to make ay significant inroads into this.

Secondly, the likelihood of success with a genetic based approach is pretty low. We might be able to say things like "black people tend to get more benefit from calcium channel blockers for high blood pressure compared to an ACEI" but on an individual basis that's less convincing.

Thirdly, the evidence base from the clinical trials we do base what we know on is AWFUL. Shoddy, self-interested poorly performed research with drug company claws all over it. There are exceptions, but the profession is currently struggling with how to 2.0 the peer review process so that it is as valid as its goals are.

Lastly, the problem is not 'lazy physicians'. We don't order a test that doesn't exist because we can't be bothered, any more than you couldn't be arsed getting fresh moon rock to hold your door open this morning due to your inherent idleness. If a way to select a better drug based on the patient does exist (there are a few ways this can sort of be done, but they are all subpopulation rather than individual based) then it will be used - it just has to be cost effective, accurate, outcome-changing, and valid.

What he is saying is that if we divert our time, energy and money into something that works, could significantly reduce the burden of disease, and has a lot of 'bang for buck' in terms of healthcare dollar, then that would make more sense than investing squillions into something that probably won't work, and even if it does, it will affect a small number of people at great expense.

The drug companies fired all their pharmacists and chemists a few years back because they thought the future was molecularly engineered drugs based on 3D models of receptors. Dismal failure. They had to rehire. Just because we can think of a theoretical treatment, doesn't mean it will work. This is similar. Do the research, see what it shows. If it works - great. If not - move on to another idea or refine it.

Re:What Personalized Medicine Is For (1)

Samantha Wright (1324923) | more than 2 years ago | (#38762002)

I apologise for being overly broad, and I most certainly did not mean to attack physicians as a group; I was merely commenting on one way in which a very vague-sounding term might be abused. I'm currently working with a lab conducting just such a study on two very specific antidepressants, but I'm under an NDA.

Not only that (1)

Sycraft-fu (314770) | more than 2 years ago | (#38763096)

But maybe it can lead to better knowledge of what lifestyle factors matter to an individual. This idea that there is the One True Lifestyle is just as silly as the idea that one drug works for all. Different people have different things they need and so on. This would be why there are those people who can drink and smoke and not exercise all their life, and yet live to a ripe old age (my grandpa is one of those). For most people, those choices are harmful, for some that matter little to not at all.

Or things like "Don't eat salt, it'll raise your blood pressure," no actually, that's not at all the case. Some people will not have high blood pressure, it just isn't a problem for them. Salt intake is totally irrelevant to that for them. Others will have high blood pressure and reducing sodium intake won't do anything for it, it will require other things. Others still will have their blood pressure affected by sodium intake, and thus will need to limit it to keep their blood pressure under control.

So it would be great if we could figure this out, and tailor medical advice to the individual. Figure out what is and isn't important to that person.

This article ignores one of the larger benefits (0)

Anonymous Coward | more than 2 years ago | (#38761304)

We're all focusing on the claim that personalized medicine is being used to exclusion of usual prevention. I don't think anyone is claiming that it will replace prevention. The argument here is ignoring other benefits.

One of the very real uses of personalized medicine/genomic diagnostics is treatment sensitivities. CYP450 is a perfect example of a variant that determines how you will react to medication. There are subsets of cancer that will respond to certain treatments and not others, and this is a way that we can elucidate these sorts of things.

Disclosure: I work on this stuff. It is a fishing expedition, but the benefits are very much worth it.

He's a pragmatic dinosaur? (2)

Idou (572394) | more than 2 years ago | (#38761354)

There are examples of people who have been very absusive to their bodies and yet lived long, healthy lives (Ossy, anyone?). There are other people who seem to be cautious enough, yet deal with various health issues. Having better information up front about one's own genetic risks allows for better decisions based on reality, not "professional" opinions founded on years of "experience" of observing the outputs of a very complicated black box by your doctor.

Bottom line, DNA is the source code of how our bodies work. Some may think it is pretty useless at this point, but we will only truly understand its value once we understand it. Most of science works like this . . .

all jobs needs paid sick days as some places (1)

Joe_Dragon (2206452) | more than 2 years ago | (#38761496)

all jobs needs paid sick days as some places make sick people come in to work and even with paid sick days to many boss have the suck it up idea and that just get's the full office sick. In foodservice this get's others sick as well.

One major problem with medicine. . . (0)

Anonymous Coward | more than 2 years ago | (#38761530)

Is that most people don't want to live healthy lifestyles. And, you know, I could care less. If someone wants to kill themselves slowly by smoking, drinking, being sedentary, and eating garbage, so be it. In a free society, with free association and free expression, one SHOULD be able to live badly or even kill themselves, provided they aren't hurting anyone else. I might not agree with it, but it's not my life, and from a moral standpoint, I have no right to impose my concept of lifestyle on them.

Hurting others in their family (1)

tepples (727027) | more than 2 years ago | (#38762070)

In a free society, with free association and free expression, one SHOULD be able to live badly or even kill themselves, provided they aren't hurting anyone else.

People with medical problems might be hurting others in their family. And they might be hurting the general public when they turn to crime to support a way to get healthy again, as dramatized in the 2002 film John Q.

Wrong question but right answer (3, Insightful)

RandCraw (1047302) | more than 2 years ago | (#38761700)

The goal of personalized medicine is to identify which genomic pattern in a population will respond to a given drug, or identify which drug will work for a given person's genome. It has nothing to do with improving public health policy and only tangentially with reducing health care costs. It has a lot to do with reducing time-to-treatment and making drugs more efficacious.

Emanuel is right that it's nuts to waste money on gene-based treatments which target only the symptoms of disease, when fixing the disease itself necessarily requires a change in lifestyle, which is something that technology cannot and will not fix. Once we accept this, the next step is simply, "How"?

All western countries are healthier than the US. Let's start by looking at what they're doing and then reward americans for doing more of that.

Deadlines (1)

InsertCleverUsername (950130) | more than 2 years ago | (#38761916)

Dr. Emanuel's thinking seems right on this; there's evidence that "genetics only account for approximately 20 to 30 percent of an individual's chance of surviving to age 85." (see Scientific American [scientificamerican.com] ) Maybe rather than provide cures, personalized medicine could be used to give people a more accurate estimate of how long they're going to live, based off various lifestyle decisions. Nothing motivates like a deadline.

False Dichotomy (1)

DaveV1.0 (203135) | more than 2 years ago | (#38761966)

Is Emanuel a dinosaur or a pragmatist?

Of course, the submitter left off the fact that he might be neither a dinosaur nor a pragmatist. Rather, he could be quite correct in his assessment.

Exercise is HARD! (-1)

Anonymous Coward | more than 2 years ago | (#38762492)

I'd rather pay $50 - $100 / month in copays for pills!

Bad lifestyle is a choice, bad genes isn't (1)

Kjella (173770) | more than 2 years ago | (#38762550)

Honestly, if you do the things you do you've decided that the perks outweigh the disadvantages. If you decide that gorging at McDonald's is better than eating a salad, that's a choice. If you decide a night out on the down getting seriously drunk or high is worth it, it's a choice. As long as I've paid plenty money in beer taxes and you can probably chop a year or two off my pensions relative to the healthy guys to cover any alcohol related injury or illness, what business is it to anyone else if I choose to poison myself? Because, yeah that's the toxic part of intoxication and in mild forms it's very comfortable. And I still expect good medical treatment because I have paid for that extra risk, least that's the way I feel it works here in Norway with high alcohol tax and universal healthcare. Same with smokers, they surely pay more than the cost as there's a real witch hunt out for them. They don't tax drugs because they're illegal and McDonald's because they haven't found a good way, but I'm sure they want to. Oh yes, and I'm aware that's not entirely true that it's my own business since you have things like a few people getting aggressive and violent when drunk, but the health effects are my business.

People with bad genes though, they can't help it. They never had that choice, they were born with the choice already made for them. Maybe a few things you can help with - like more intense cancer checks if you know you're predisposed for cancer - but I'd say the far more interesting part would be looking for cures, before you even get so far as the disease. Oh you're predisposed to cancer, here's a shot of retrovirus that will change those genes before it even gets so far. Or better yet, if we find people with immunities or other good qualities we can use that almost like a vaccine. Natural selection has practically no effect when you're past the age people get kids, if we want to live longer and healthier we'll probably have to manipulate our bodies to do that ourselves. And don't give me anything about my genes being who I am, if you offer me a gene-altering drug so that'll I never get Alzheimer's and end my life like a mindless zombie I'd take it. Feel free to refuse, I hear there's people that won't even take blood transplants and I respect that, just don't expect me to agree with them.

Personalized medicin is NOT just genetics (1)

gurps_npc (621217) | more than 2 years ago | (#38762880)

Any person with a single serious disease has to get personalized medicine.

I am constantly bombarded by idiots telling me things like "eat less carbs", but my personal medical issues makes eating more protien worse for my body than eating carbs.

ALL medicine should be personalized - not just for your genes, but for your particular conditions.

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