Tuesday, December 8, 2009

Adaptive Medication

I, like an increasing number of 40+ humans, am taking medication to lower my blood lipids in the hopes this reduces my risk of heart disease. For quite a while now I've been twisting my GP's arm (gently), trying different medications to see if there is one that will fit my personal genotype better. The motivation for this was the recognition that the usual "best" medication - according to randomized studies of large populations, wasn't doing the job for me. It occurred to me that genetic variation among people means that some people will respond better than others (duh.), and hence, the only way to work out what works for me, is, well, Adaptive Medication. Try something new. Test. Try something else. Test. Initially I tried to work out a model of cholesterol synthesis to generate some hypotheses but gave that up. If you think climate scientists are having trouble coming up with good models you should see physiologists. I knew there was a reason I never took biochemistry as an undergrad.

Thus I was intrigued by Pascale Hammond's discussion of how a clinical health care provider works and why this is science. Frankly I couldn't agree more - but the AMed spin raises an interesting point about what happens with all the data generated by those diagnostic tests of differential diagnoses. Unless I give my GP explicit permission, that information is not usable to improve medical understanding. Millions, nay, Billions or Trillions of dollars spent every year testing hypotheses and none of it used to advance the underlying science. I understand that there are privacy issues, but ... but ... this is my potential future longevity that is suffering! Maybe there would be a way for individual patients to "volunteer" to have their diagnoses and test results entered into a global double-blind database in much the same way that gene sequences are.

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