Sun, Dec 30, 2012 - Page 9 News List

Personalized medicine’s perverse economic discrimination

By Donna Dickenson

Personalized medicine is not the only factor undermining the pharmaceutical industry’s profits. Patents on many best-selling drugs are expiring, deepening the urgency of finding new markets.

Pharmaceutical companies can create new niche markets by persuading customers that they cannot rely on a one-size-fits-all product, and by breaking down existing medications into different “size ranges.” Their best option would be to persuade individual patients to pay out of their own pockets to learn which of the niche pharmaceuticals is their “size.”

Now that an entire genome can be sequenced for only US$1,000, online direct-to-consumer genetic firms may well extend their reach from gene subsets to whole-genome mapping.

CUTTING COSTS

In this case, diagnostic costs would be transferred from the public-health system or insurers to the individual. However, that could lead to new problems, particularly if some individuals are excluded from coverage on the basis of the genetic profile for which they have paid.

Moreover, even if pharmaceutical companies raise prices, there will probably be some combinations of pharmacogenetic drugs for which the market is simply too limited. Patients with cancers driven by different genetic pathways would require such diverse drug combinations that producing every drug required for each patient’s ideal regime would not be feasible. Indeed, as medicine becomes more personalized, the range of customers for each drug narrows, weakening pharmaceutical companies’ incentive to produce them.

Personalized medicine appeals to our desire for choice and autonomy. However, we should be careful what we wish for. Patients’ enthusiasm for pharmacogenetics would be dampened significantly if it served as a rationale for national health systems and insurers to deny them treatment. And, with governments and companies worldwide cutting costs, that may well be the shape of things to come.

Donna Dickenson is emeritus professor of medical ethics at the University of London.

Copyright: Project Syndicate

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