Banner by Khusbu Patel
Ethics of Personalized Medicine
by Ripal Sheth
You walk into your doctor’s office for a general physical examination. The doctor begins the standard routine: checking your blood pressure, heart rate, and respiration. At the end of the examination, he reveals a diagnosis of hypertension. He suggests some general lifestyle changes to start lowering your blood pressure and scribbles down a prescription for Vasotec. After a couple of weeks of taking the medication, you start experiencing side effects, but you are still able to deal with them. Eventually, however, you become unable to work. You ask your doctor about changing medication and see fewer side effects, but you still suffered through weeks of pain and discomfort from the previous medication. This scenario is commonplace; patients often must try multiple medications to see what works best for their own body. Although genome mapping and advancing pharmacogenomics would make these current prescription practices obsolete, there are potential dangers — including violation of patient rights and pharmaceutical exploitation.
Medicine has generally functioned as a “one size fits all” model, with one treatment given to most or all people despite individual variation. However, it has long been known that some patients respond to certain medications better than others. The molecular basis for this phenomenon was not thoroughly examined until the development of pharmacogenetics, which considers how genetic variation among individuals leads to differential responses to medication. As genetic testing and human genome mapping become increasingly popular in the healthcare field, the possibility of implementing knowledge from pharmacogenetics into the ever-evolving field of personalized medicine could be brought to fruition. Personalized medicine uses knowledge of an individual’s environment, genes and medical history to tailor treatments to their particular circumstances. Although the concept of personalized medicine is ideal, there are some ethical and practical issues that pose important challenges to the development of personalized medicine in the healthcare field.
According to the Hippocratic Oath, physicians are required to uphold the principle of nonmaleficence; they are to do no harm to their patients. Generalized prescription practices may violate this principle since they do not consider the more specific information available through pharmacogenomics. The implementation of personalized medicine might allow for physicians to uphold this core principle to do no harm by critically analyzing the circumstances of an individual against the treatment they are prescribing. However, if insurers decide to require genome sequencing as a result, a patient’s right to refuse sequencing could be diminished due to increased costs.
Because different people would be prescribed different treatments with differing costs, personalized medicine could also have a particularly adverse impact on those with lower socioeconomic standing. For example, one family might be able to afford a specific cancer treatment for two months because the information obtained from personalized medicine led to the prescription of a more expensive drug. Another family might be able to afford two years of treatment because they were prescribed a lower-cost drug. This leads to the risk of pharmaceutical companies exploiting certain populations based on characteristic genetic information to hike up prices for certain treatment options, leading to disparities in healthcare accessibility.
We must also consider that the information gathered so far about the human genome is not enough to reach a solid conclusion about the impact of genetic and environmental factors on the individualized effects of given treatments. The field of pharmacogenetics is relatively new, and researchers are still trying to elucidate the function of many human genes. This lack of knowledge could lead to the prescription of drugs with debilitating side effects. The obvious solution to this problem is to continue research on the human genome to better understand the effects of genetic variation on drug interactions. However, although researchers can use model organisms, eventually actual human subjects will have to be considered. This leads to ethical questions surrounding the use of patient information for scientific progress — it could be possible for researchers to use genetic information without patient consent.
Despite the practical and ethical issues that face the large-scale implementation of personalized medicine, its obvious benefit is the ability to allow physicians to make more informed decisions to do the least harm to their patients. The future of medicine is likely moving towards the consideration of genetic information, environmental factors and medical history to create more individualized treatment plans. In light of the advances made in genome sequencing and pharmacogenetics, the one-size-fits all model that has long been used by the healthcare field must be adapted to provide better care for patients.