tag:blogger.com,1999:blog-1812431336777691886.post4255264315406078097..comments2024-02-29T03:57:00.088-05:00Comments on The Mermaid's Tale: What's 'precise' about 'precision' medicine (besides desperate spin)?Anne Buchananhttp://www.blogger.com/profile/09212151396672651221noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-1812431336777691886.post-84185592616552573002015-01-27T07:46:24.032-05:002015-01-27T07:46:24.032-05:00I did not mean to imply that there is no promise a...I did not mean to imply that there is no promise and that no research should be done. There is promise, but there is also hype, and I see no way that genomics can live up to the hype in the foreseeable future.Michael Finfer, MDnoreply@blogger.comtag:blogger.com,1999:blog-1812431336777691886.post-84883879058915226192015-01-26T08:27:02.714-05:002015-01-26T08:27:02.714-05:00Reply to Drs Littleboy and Finfer:
Overboard? It&...Reply to Drs Littleboy and Finfer:<br />Overboard? It's bluntly worded, not smoothly written or elegant perhaps, but it's nothing compared to the full-court press being applied by Francis for this.<br /><br />This is a zero-sum 'game', too. In tight times one might even say negative-sum. What is funded for one purpose, directly deprives other aims of funding. In tight times, with many careers (and hoped-for careers) in the balance, it's not time to mince words.<br /><br />Also, I think the statements we made are, basically, cogent and -- yes, NIH! -- evidence-based!<br /><br />Science can't predict discoveries because Nature challenges us in deep ways. But we can hope to raise the odds of major findings by exploring new paths.<br /><br />Playing it safe and the inertial, almost anti-entrepreneurial tactics that we're seeing are totally understandable tactics but which don't seem like the best way to get science for the public good.Ken Weisshttps://www.blogger.com/profile/02049713123559138421noreply@blogger.comtag:blogger.com,1999:blog-1812431336777691886.post-66109814688338135292015-01-26T07:56:03.936-05:002015-01-26T07:56:03.936-05:00Precision is a badly chosen word. It refers to th...Precision is a badly chosen word. It refers to the reproducibility of results, that if you do a test more than once, you will get, more or less, the same result.<br /><br />I have been wondering where all this genomic stuff is going. If any of it pans out, all it will allow us to do is stratify patients by risk. I doubt that it will allow us to predict with any accuracy whether a five year old will eventually have an myocardial infarction, much less a premature one. I, of course, am not referring to those rare patients with single gene abnormalities, but to the rest of the population.<br /><br />However, I have always had hope for the application of sequencing of simple organisms in reducing the amount of time that it takes to identify the cause of an infection and to determine which antibiotics it is susceptible to. That can currently take anywhere from a day or two to two or three months for an organism like Mycobacterium tuberculosis. Even for that, we are nowhere near ready to go. These techniques are so sensitive that it might be difficult to sort out what is going on, especially in a typically non-sterile specimen like sputum, where you will get many (hundreds or more?) of organisms identified and then have to sort out what you have to treat.<br /><br />Sometimes I wonder if any of the most prominent researchers remember anything about the art of diagnosis. Some of them seem to think that everything can be computerized, and I don't see that happening in my lifetime.Michael Finfer, MDnoreply@blogger.comtag:blogger.com,1999:blog-1812431336777691886.post-58770574812765224852015-01-26T06:43:11.172-05:002015-01-26T06:43:11.172-05:00Hmm. I think you've gone a bit overboard. I ag...Hmm. I think you've gone a bit overboard. I agree that "precision" is a badly chosen word, but I'm hoping that genomics will lead to the following sorts of improvements. A given medication will produce improvements in such and such a percentage of patients (i.e. have a specific number to treat) and side effects in a different percentage of patients (number to harm). If one could use genomic information to increase and decrease those numbers even just a bit, it'd be big. (This could be enormous in cancer treatment.) As a white male of a certain age and medical history, it turns out I have a 12% chance of a heart attack over the next 10 years (according to the Framingham calculator). If I am going to have said heart attack, it'd be real nice if I'd been taking an aspirin every day. But aspirin has a certain chance of causing a variety of other problems. If genomic info could tell me even slightly more accurately how likely those other problems are, I'd have a better way of deciding what to do.<br /><br />In real life, though, my bet is that genomics is going to be a stupendous fizzle for the simple reason that all the low hanging fruit is obvious from family history, and the higher fruit is really tiny (so tiny, it can't be seen in family histories, doh). Sigh.<br /><br />Even worse, the kinds of studies required to figure out genomic effects in number to treat or number to harm values are expensive, time consuming, and unlikely to get done. Sigh, again.<br />David J. Littleboynoreply@blogger.com