To recap from my last column, “It’s Your DNA, Stupid!” I dove right into the fact that “personalized medicine” is a real thing now. Meaning, the chance to help people fight their disease on a molecular and immunological level, rather than the traditional “napalm everything” approach, is evidence of true scientific progress as a direct result of the Human Genome Project. Thank you, smart people.
Granted there are barriers to implementation: Improved outcomes and general measured success leveraging these new treatments are great in number, e.g., access, awareness, standards, literacy, navigation, recruitment and the mind-numbing process of signing your life away when you enroll in a trial.
Like anything in life, it’s all about risk. Risk for the patient. Risk for the doctor. The hospital. The academic researcher. The drug company. Everyone.
It gets complicated: Risk ties into so many different aspects of care—and how risk is presented to patients is unto itself a Tolstoyan tome. The very nature of these genomic miracles of medicine is about risk, predisposition to disease and inherited traits passed down to progeny—and the cost/benefit of whether the medicine will help or not.
These new drugs are so futuristic, they almost don’t care about your cancer at all. They care about your DNA, which may have put you at risk in the first place for disease.
Soon, they will find a gene for every kind of cancer, which means there will need to be a drug for every gene—that changes everything we know about medicine, double-blind studies and trials in general.
We’ll have one drug for 30 people a year with the “ABCD” gene mutation for eyebrow cancer. It will have taken a few years and a billion dollars, and cost $50,000 per pill—but we’ll have some kind of cure, right? But then those 30 people have 30 children who may now be carriers of the ABCD gene and could get eyebrow cancer. They are at risk. Can they be tested? Should their eyebrows be removed? Is this the new cancer prevention in a molecular science world?
Prophylactic bilateral mastectomies underscore our new culture of risk, perceived or actual. I wonder how many body parts you can remove and still keep a decent quality-of-life. Breasts, ovaries, tonsils, gallbladder, appendix and so on. All worthless if they’re going to turn against us someday, right?
The trials of today foster the risks of tomorrow. The very nature of cancer prevention is changing from proactive to reactive. I’d bet that removing every non-essential body part would only reduce your risk of getting cancer—not prevent it. You’ve still got lungs, blood, bones, soft tissue and other vital organs.
As someone born with brain cancer, I had no chance of prevention—and risk wasn’t even on the radar. I ask, “What is it all worth?” How do we evaluate the human condition in an age of near-science-fiction-levels of progress and innovation that have opened a Pandora’s box as to the pros and cons of possessing 23 chromosomes?
“I’ll put it this way: Risk is what you make of it. You could panic all day long because environmental toxins, GMOs, cell phones, pollution—all things you cannot control—contribute to free radicals and immune system compromise. Or, you could get busy living and make every moment count.”