The Takeaway First

No two people are the same, and the only way to treat disease effectively is to see that there is noone way. Treatment is usually better when personalized.

Standardized Medicine?

Dr. Kathy Miller, MD put up a video online last month in which she raised a provocative question: “Will clinical pathways go the way of the dinosaur?” Clinical pathways, if you don’t know, are sets of standard methods or guidelines (you might call them road maps) for the treatment of disease. They were first invented in the ‘80s as a way to make the healthcare industry more efficient. These systems have proven to cut costs and shorten hospital stays (Chang et al., 1999; Chen et al., 2000; Renholm, Leino-Kilpi, & Suominen, 2002; Dautremont et al., 2013), but still Miller is not happy with these systems. In her words,

“[A]t their core they assume that one patient is like another; that our diseases are finite in number; and that the appropriate first-, second-, and third-line treatment can be identified on the basis of the disease, not taking into account who the patients are.”

My Take on This

I think Miller raises an excellent point here. It’s a core principle of my practice that care has to be tailored to the individual. After all, no two patients are alike. Not only do people’s genes differ, but the way those genes are expressed differs as well. The expression of genes is affected by more factors than I could practically list here, but diet, lifestyle, and cognitive processes play a big part (Fay & Kussmann, 2008). These unpredictable factors will interact with any treatment provided, so of course the treatment that takes them into account will be a lot more precise, and potentially more effective.

The process of diagnosing a disease is not simple. Usually the symptoms for one disease are also the symptoms for another disease, and what one doctor calls a disease another doctor might call a symptom. Erectile dysfunction (ED) is one that comes to mind here. ED usually means that something else is going wrong, but exactly what is going wrong with the individual is not something you read in a book. Good doctors are like detectives looking for clues in every aspect of a person’s life.

Even though clinical pathways have cut costs and had some other practical benefits, I’m glad that in New York I’m not expected to follow them (at least not yet). While lowering medical cost is clearly important, it should never be in the expense of my patient. More often than not, I see patients with non-textbook health problems where personalized medicine is required. Some of my patients have cholesterol levels up to 50 points above the rest of their cohort, but that’s normal for them. Should they be on a statin drug because they don’t match up with everyone else’s normal? I don’t think so. Same holds true with the controversial prostate marker PSA – higher values are often normal in some patients. My patients aren’t diseases that I read about in a book; they’re people with histories, beliefs, and unique experiences.

The Bottom Line

Seek personalized care when you can. The best doctors and best medicine doesn’t solely treat disease; it treats people!