On August 6, 2023, in anticipation of a book to be published in the fall, The New York Times ran a provocative opinion piece titled “Personalized Medicine’s False Promise” in which University of Utah Professor of Philosophy James Tabery dismisses the promise of personalized medicine — delivering the “right treatment, to the right patient, at the right time” — based on his father’s experience as a cancer patient over a decade ago. After a diagnosis of late-stage lung cancer and treatment with a targeted therapy, erlotinib, Tabery’s father lived for one year — at, as Tabery notes, a very high cost to the insurance company that covered his father’s medical expenses.
There are several problems with Tabery’s contention, based on his father’s experience, that physicians are on the wrong track in seeking to determine the underlying molecular basis for each patient’s cancer and treat it accordingly.
First, the world we are living in today is not the one that Tabery’s father encountered 10 years ago. Even in Tabery’s father’s case, the prescribed drug extended his life for a year, which many oncologists might argue was better than expected if the drug had not been available.
Moreover, since the death of Tabery’s father, some 200 additional personalized medicines have come to the market. Many extend life and reduce cancer deaths, giving cancer patients hope and sometimes promising cures. Indeed, in the last five years, more than a quarter of all U.S. Food and Drug Administration-approved drugs have been targeted medicines, that is, drugs designed to treat individuals based on their molecular profiles and approved by FDA because they improved overall survival relative to existing standards of care.
As Tabery notes, personalized medicines come with high price tags, in part because they must recoup research and development costs from limited markets, sometimes as small as a single patient, and because they are hard to discover and develop. But personalized medicines also promise to reduce the overall costs of health care because one-size-fits-all medicines are also expensive for patients and health systems, mainly because they are prescribed to everyone whether they work or not. It is difficult to envision a future in which it will make sense to forego the sophisticated efficiencies of personalized medicine in favor of wasteful trial-and-error approaches that leave too many patients sick for too long.
Tabery argues that we would be better off “focusing . . . on the environments we share than on pursuing genetic cures that divide people into categories.” But personalized medicine and public health are not zero-sum investments, and they should not be seen as such. They are, in fact, partners that together push back the frontier of illness, notably in reducing the number of deaths from lung cancer, which, according to the American Cancer Society’s annual report on cancer statistics, have been rapidly declining due to smoking cessation, but also due to early detection and many more targeted therapies that did not exist 10 years ago.
My father also died from cancer, albeit in the era before genomic medicine offered the hope that Tabery’s column laments. Treated at one of the nation’s best hospitals, he underwent surgery, followed by chemotherapy, and, when those didn’t work, massive amounts of toxic radiation, none of which slowed the cancer’s spread.
I prefer to live in today’s world and have never met a patient who didn’t as well.