Ezra Klein suggests that personalized medicine, the use of genomics to tailor treatments to patients based on their individual genomes, will lead to increasing inequality in human health.
He was reporting on the argument of Francis Collins, the Director of the National Institutes of Health, that genomic technology will lead to huge advances in medical treatments.
As Collins sees it, what’ll be revolutionary about genome-based medicine is that we’ll be able to use the information contained in an individual’s DNA sequence to target their therapies much more precisely. If that comes true, the treatments of the future will differ from the treatments of the present in two big ways: First, they’ll work a lot better... Second, there’ll be a lot more individual variation,.. [and] one byproduct will be an immense explosion in health inequality. Right now, health inequality, though significant, is moderated by the fact that the marginal treatments that someone with unlimited resources can access simply don’t work that much better than the treatments someone with more modest means can access... But as those treatments begin to work better, and as we develop the ability to tailor treatments to individuals, we should expect that someone who can pay for the best treatments for their particular DNA sequences to achieve far better health-care outcomes than someone who can’t afford the best treatments and has to settle for general therapies rather than individualized medicine.
I agree that powerful, far future health technologies will likely increase human inequality. I made a similar argument about the effect of genetic enhancement technology in the Journal of Medicine and Philosophy in 1995 (and if you are interested in ethical discussions of genetic enhancement, I recommend Allen Buchanan's forthcoming book).
That said, I am not worried that personalized medicine will create significant health inequality anytime soon. Here's why. The idea behind personalized medicine is that for a given treatment, there will be one or more alleles that make a given drug more or less effective for a subgroup of patients. If your doctor knows that you have one of these alleles, she can make the treatment more effective for you by appropriately adjusting the drug.
I am confident these gene-drug interactions exist. But keep in mind that many alleles are quite rare (1% prevalence or less). If so, then we have something like an orphan drug problem, that is, there are too few people with the condition to make it profitable to the manufacturer to carry out the research to develop the genomically-driven treatment guideline. That might not be the case if the effect was extremely powerful. However, most of the novel health effects uncovered in genomic research have been small.
I hope that Collins is right, and that we find gene-drug interactions that advance medicine, even if this has side effects in increasing inequality in health. So far, though, I'm not seeing them.