What is genomic precision medicine, and for whom?
A simple point to orient yourself. For everyone.
Genomic “precision” medicine. The genetic profiling of the cancerous tumour. We read and hear lots of things. Why should it be done in all cases of cancer and what is it for?
Genomic “precision” medicine, as opposed to industrial medicine
Today, cancer cases are treated with drugs that work well and save many patients without the need for genomic “precision” medicine. From a public health point of view, we could say: ok, it does the job. Period. And improving the effectiveness of treatments will increase the number of patients saved. This is the industrial approach that works very well in factories. As long as we do not exceed a fixed waste rate, everything is fine, and the defective parts discarded do not come to haunt us at night. But here we are talking about medicine and human beings. For the sake of argument, let’s establish that the non-waste rate is 80%, and the waste rate 20%. Or we can set a ratio of 90% on one side and 10% on the other. It does not matter anyway, because it is inaccurate. The key is to understand that there is a majority group, driven by Big Pharma and public health, as opposed to a minority group (those who are not responding to traditional treatments). Advanced genetic testing will serve only the minority.
The seatbelt in the car only saves those who will have an accident. However, everyone must wear it because we do not know in advance who it will benefit. It is a small inconvenience for everyone, but a great benefit for drivers and passengers who (alas) will experience a collision or an accident. In terms of cancer, there are those who will respond well to common cancer treatments, commonly prescribed by oncologists, if you will. And those for whom anticancer drugs will not have the desired therapeutic effect. In our comparison with seat belt wearing, this is the group of “casualties”. Applying genetic screening to all cancer diagnoses will be a minor inconvenience to the majority, but it will help ensure that the minority is oriented in the right direction. This is important because anti-cancer treatments are heavy, exhausting for the body already affected by cancer, and last for a long time. This is not something you get over with in two shakes of a lamb’s tail, right? And if you finally end up getting the right chemotherapy treatment, but your body is too exhausted, roughened up by the misguided ones before, you are not being given the best possible chances. At this point, you may ask: what if there is no existing treatment for a patient? It is indeed possible. Well, even in this case, even if there is no suitable treatment or option (chemo, surgery, CyberKnife …) we can talk about loss of quality of life and chance of survival for the patient belonging to the minority group (but he or she never knew it). More than once, I heard this cruel joke: “At this point, we dunno what killed the patient. The rounds of aggressive chemotherapies, or the patient’s cancer disease.”
Now, think of the genetic profiling test of the tumour as a compass. A tool. It will help guide the patient to know which group he belongs to. Majority or minority. You must not wait to be frozen to the bone, lost in the middle of the huge forest, to get out your compass and use it. You must start using it right from the beginning of the trip. Hence, we must guide all patients early, so that the minority group does not suffer a penalising and inefficient treatment, otherwise we remain in the logic of defective parts in the industry instead of human beings.
Primum non nocere. First do not harm.
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