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What if... the future of epidemiology?


The pros and cons of individualized patient therapy
Baruch Blumberg Physician
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The practice now is, you don't treat carriers unless they have symptoms. Now, the symptoms may be abnormal liver chemistry or an abnormal biopsy. And, actually there may be very little perceived symptoms. But you don't treat… carriers if they have no symptoms, or they have no clinical findings, and serological findings. That's the issue. And, so… but… but this argument that you really don’t have to use a lot of drugs, you know, if you only have to keep it to a certain level. So, what I'm trying to urge people to find out now, you know, to determine — and I've been speaking to the drug companies about this for several years — is just, what the level is. Now, it can only be, kind of, you know, it's going to vary from person to person, and one day, you may be able to find that out too, based on this genomic analysis, you know, looking for susceptible, genetic susceptibilities in an individual; if they have a particular allele, that may indicate that you want to go to a certain level. I mean, that can all be determined in time. You know, empirically, you're actually making an observation. And then you could particularize the treatment, and decide some people are never going to have big problems, and others are. And that's what we're, when we started this stuff on polymorphisms, that was our kind of hope. And you'll know with the SNPs, and all the possibility of looking at polymorphisms in great numbers, that again, is the kind of promise. Now, it has a lot of potential hazards, and there may be a lot of several, total show-stoppers, but it means you, kind of, particularize medicine — individualize medicine where you find out what the risks are and then try and mitigate them. Now that has dangers connected with it, because people don't really understand the concept of risk. They equate risk with certainty. When you have the RAC2, certain women, they do mastectomies, you know, in asymptomatic… you know, that's a pretty big consequence. So you can see the possible hazards, but… but also the potential benefits, because you'd have to balance the treatment; I mean, you wouldn't want to give a treatment that is, if you can avoid it. You want to devise certain benign treatments that, generally speaking, improve your health one way or another. And you can conceive of that happening. The problem is, a lot of this is drug driven, so the only things that, very often, get funded are the ones that are… are based on drugs, they’re based on something you can sell, essentially. Well, nevertheless, I think that's going to be a direction, that's, kind of, really going to be amplified now. My great concern is that it's going to, kind of, get out of hand. And if your motivations are to sell drugs, you know, then that… that's going to be an issue, because that's going to affect your judgment about how to proceed. But that's an issue in… in contemporary medical treatment.

American research physician Baruch Blumberg (1925-2011) was co-recipient of the Nobel Prize in Physiology or Medicine in 1976 along with D Carleton Gajdusek for their work on the origins and spread of infectious viral diseases that led to the discovery of the hepatitis B virus. Blumberg’s work covered many areas including clinical research, epidemiology, virology, genetics and anthropology.

Listeners: Rebecca Blanchard

Dr Rebecca Blanchard is Director of Clinical Pharmacology at Merck & Co., Inc. in Upper Gwynedd, Pennsylvania. Her education includes a BSc in Pharmacy from Albany College of Pharmacy and a PhD in Pharmaceutical Chemistry from the University of Utah in Salt Lake City. While at Utah, she studied in the laboratories of Dr Raymond Galinsky and Dr Michael Franklin with an emphasis on drug metabolism pathways. After receiving her PhD, Dr Blanchard completed postdoctoral studies with Dr Richard Weinshilboum at the Mayo Clinic with a focus on human pharmacogenetics. While at Mayo, she cloned the human sulfotransferase gene SULT1A1 and identified and functionally characterized common genetic polymorphisms in the SULT1A1 gene. From 1998 to 2004 Dr Blanchard was an Assistant Professor at Fox Chase Cancer Center in Philadelphia. In 2005 she joined the Clinical Pharmacology Department at Merck & Co., Inc. where her work today continues in the early and late development of several novel drugs. At Merck, she has contributed as Clinical Pharmacology Representative on CGRP, Renin, Losartan, Lurasidone and TRPV1 programs and serves as chair of the TRPV1 development team. Dr Blanchard is also Co-chair of the Neurology Pharmacogenomics Working Group at Merck. Nationally, she has served the American Society of Clinical Pharmacology and Therapeutics on the Strategic Task Force and the Board of Directors. Dr Blanchard has also served on NIH study sections, and several Foundation Scientific Advisory Boards.

Tags: symptoms, disease carriers, drug treatment, particularized medicine, genomic analysis

Duration: 3 minutes, 17 seconds

Date story recorded: September 2007

Date story went live: 28 September 2009