Personalised Medicine
A tailor-made suit being fitted
By chance I happened to hear a playback this morning of Pat Kenny’s interview with Prof Luke O’Neill of the School of Biochemistry and Immunology at Trinity College, Dublin. I was delighted to hear Prof O’Neill is promoting the idea of personalised medicine but was amazed at his lack of knowledge of medical history and of the man who trod this ground more rationally and thoroughly, 200 hundred years ago, than Prof O’Neill: Dr Samuel Hahnemann.
The current idea of personalised medicine presented by Prof O’Neill is a crude and irrational version of individualised medicine – the very thing medicine abhors according to Dr Richard Moskowitz (himself a doctor and Harvard graduate in biochemistry) – as taught and proven by the great Dr Hahnemann.
Problems with Personalised Medicine
There are a number of problems with personalised medicine. Prof O’Neill explains that there are individual responses to medicines. But drug companies will not make hundreds of medicines to treat rationally and scientifically the plethora of possible responses.
A connected problem is that apart from individual responses to drugs, the therapeutic application presented here is fallacious. The idea is now to “tailor” drugs to a limited number of disease names. Disease names are a human construct and disease names purely a convenient means to making prescribing easy and convenient but no two people fit into the same disease name.¹
Furthermore, treating one “disease” in a person is superficial because usually a person will have symptoms other than those which fit into the disease name. This means the symptoms are likely to be suppressed eventually making the person worse, whatever about the “disease.”
Another mistake is Prof O’Neill’s understanding of disease and people as being mechanical. A typical error of modern materialistic science. This will lead to the “fixing” of more than one broken part and will require more than one drug – the problem of polypharmacy Prof O’Neill didn’t raise.
Another question which his talk raises is the reduction of disease to a gene. We are always more than our genes. Why should a disease begin at a certain time when the gene was there all along? A dead person has the gene which supposedly caused their illness but they are not sick now! This brings us to the blind spot in medicine – life, vitality (see my tags on vitalism).
Pat Kenny raised the question of drugs affecting the whole person rather than targeting the problem area. Prof O’Neill says we are now hitting the hub of the matter – if he knows the hub of disease he’s rare as disease is invisible (as I’ve explained here and here). Since we may have to hit many “hubs”, we are now obliged to introduce the need for polypharmacy, therefore more side-effects – the very thing personalised medicine is supposed to overcome along with the obvious dilemma of conflicting actions and reactions between the various drugs.
On drug action, clarification is required for prof O’Neill’s claim that certain drugs work better at certain times. This is acceptable but his reasoning is wrong, “For example statins work better at night because the body produces cholesterol at night.” There’s a gap in the logic here. He may be correct but not for the reason he gives. Just because the body produces cholesterol at night; it doesn’t mean an anti-cholesterol drug will work best at that time. All it means is that it might be more effective to give it then to suppress the body’s action but the statin’s time of action is not necessarily at night. Also, what time at night? Drugs usually have an affinity for a particular hour or so. It doesn’t matter what time a drug is administered, it will still have its preferred time of action, regardless of the time it’s taken.
While it’s great for biochemists to acknowledge individual reactions to drugs, it’s a pity they don’t acknowledge individual reactions to diseases. But that would really upset the applecart.
There are a few more points worth noting here. First, Prof O’Neill will have to define disease which it seems he hasn’t. Secondly, what does he mean when he says a medicine “works”?, after all, a hammer across the back of the head “works” – you soon forget the pain in your knee! And personalisation in medicine isn’t rational or scientific unless the drug is homeopathic to the symptoms and it covers the totality of symptoms.
But does medicine really want personalised medicine? Probably not. As Dr Richard Moskowitz explained, individualisation is medicine’s biggest objection to homeopathy; it takes time to practise this kind of medicine and requires a larger armamentarium of drugs. Say no more!
To return to Pat Kenny’s question, “When can we see the introduction of personalised medicine?,” the answer is: two hundred years ago, by Dr Samuel Hahnemann.
Notes
1. Take “arthritis” for example. A handy name but no two people have the same arthritis: one’s joints are mostly affected on the left side of the body, another on the right; one has burning pains another shooting; one is worse for rest another better for rest; one is worse in damp the other better in damp etc etc.
References
To listen to the Newstalk interview Click Here The discussion begins about two thirds of the way through Part 1 on Saturday 30th August 2014 (just work your way back to the date!)
Further reading
Divided Legacy by Harris Coulter
Image: wikimedia