When I hear someone say “personalized medicine” I want to ask “as opposed to what?”
All medicine is personalized. If you are in an emergency room with a broken leg and the person next to you is lapsing into a diabetic coma, the two of you will be treated differently.
The aim of personalized medicine is to increase the degree of personalization, not to introduce personalization. In particular, there is the popular notion that it will become routine to sequence your DNA any time you receive medical attention, and that this sequence data will enable treatment uniquely customized for you. All we have to do is collect a lot of data and let computers sift through it. There are numerous reasons why this is incredibly naive. Here are three to start with.
- Maybe the information relevant to treating your malady is in how DNA is expressed, not in the DNA per se, in which case a sequence of your genome would be useless. Or maybe the most important information is not genetic at all. The data may not contain the answer.
- Maybe the information a doctor needs is not in one gene but in the interaction of 50 genes or 100 genes. Unless a small number of genes are involved, there is no way to explore the combinations by brute force. For example, the number of ways to select 5 genes out of 20,000 is 26,653,335,666,500,004,000. The number of ways to select 32 genes is over a googol, and there isn’t a googol of anything in the universe. Moore’s law will not get us around this impasse.
- Most clinical trials use no biomarker information at all. It is exceptional to incorporate information from one biomarker. Investigating a handful of biomarkers in a single trial is statistically dubious. Blindly exploring tens of thousands of biomarkers is out of the question, at least with current approaches.
Genetic technology has the potential to incrementally increase the degree of personalization in medicine. But these discoveries will require new insight, and not simply more data and more computing power.
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