The Future of Medicine

Welcome to Pivotal Trial, a blog that discusses various health care topics. Having written a few blogs on my own experiences (Rickety Rickshaw and Letter of Marque), I've decided to shed some light and express my opinion on current health care topics. I invite you to follow this blog and share your opinions in the comments section.

A few months ago, Steve Jobs passed away after a long and undesirably public battle with pancreatic cancer. Shortly after his death, a biography on Jobs written by Walter Isaacson was released. I read this amazing biography in a week. One of the most fascinating sections was a discussion of Jobs' life with pancreatic cancer. Although pancreatic cancer is one of the deadliest cancers, Jobs managed to live for 7 years with the disease before it ultimately killed him (2004 - 2011). Yet, the life expectancy of someone who is recently diagnosed with pancreatic cancer is only 5-8 months.

So how did Jobs manage to live so long with this fearsome cancer?

I believe the answer is the experimental approach that doctors used to treat his disease. In fact, Jobs may have beaten the disease completely had he not refused surgery during the first 9 months after its diagnosis. Jobs initially employed natural remedies to combat this cancer. While I am somewhat of a believer in the benefits of natural products, something as complicated as cancer needs the best that modern medicine has to offer. Eventually, after Jobs was convinced by his doctors and family to undergo surgery and mainstream treatment, his health improved dramatically.

Jobs was one of the few people to have his entire genome sequenced. Thus, doctors were able to select the right medicines to address his particular brand of cancer. Chemotherapeutics (drugs that kill cancer cells) are notorious for initially working against a cancer only to have the cancer 'adapt' to the drug and eventually build a tolerance to it. When this happens, doctors frantically (and randomly) try a cocktail of new chemotherapy drugs in the hopes that one or more of this drugs will hit. In the case of Jobs, doctors were able to hand pick the right drugs to address his cancer thanks to a complete understanding of his genome.

This form of treatment, a direct application of the widely touted 'personalized medicine' philosophy, is experimental and not available to the masses. A patient needs to be wealthy and have access to the best doctors who know what to do with this genetic information after it is discovered.

Personalized medicine comes in many forms: stem cells, gene therapy, etc. Seattle-based Dendreon (DNDN) applies personalized medicine by training the body's immune system to identify and kill prostate cancer cells. However, the company has fallen on hard times due to a key mistake in its business strategy - namely marketing their therapy for all prostate cancers instead of particular prostate cancers in which it is most effective. This mistake, combined with the outrageous price for the treatment, makes the data on therapy effectiveness vs. price look worse than it actually is. Thus, many oncologists have abandoned this otherwise excellent treatment.

Nevertheless, personalized medicine will live up to the hype and allow people to live longer and fuller lives. Start thinking about what you want to do in your 90s and 100s because with personalized medicine you just might get there.