When Joe Calls the Rheumatologist
At some point, Joe’s attempt to quell his pain with over-the-counter acetaminophen and nonsteroidal anti-inflammatory drugs will fail. He will decide that enough is enough, and he will go see the doctor. For you readers in the great state of Ohio, be prepared. He may show up in your office.
The questions I would like to ask in this and the next column are, what kind of healthcare would Joe like and what kind of healthcare will be available? (Trainees, this is system-based practice).
During the ACR meeting in San Francisco, I attended a brilliant lecture by Iain McInnes of Glasgow, Scotland. In his year in review, Iain talked about the aspirations of patients for better treatment. According to Iain (and I would agree), patients seeking rheumatological care do not want the best therapy for rheumatoid arthritis. They want the best therapy for their rheumatoid arthritis.
This desire—shared by patient and physician alike—is at the heart of personalized medicine. In the realms of basic and translational research, personalized medicine is emerging as a major enterprise and intellectual focus, with current genetic and genomic techniques providing an unparalleled picture of the cellular and molecular basis of illness in any Joe or Josephine. Indeed, according to projections of the avant garde, it will soon be possible to genotype and phenotype people completely and put all the necessary gene sequences, SNPs, and microarrays on a little chip to be stuffed into a wallet just like a credit card. If all goes as planned, the chip will be a personal rosetta stone to help the physician predict outcomes and devise the best therapy for the patient. For example, the chip will pinpoint, on the basis of pharmacogenetic and pharmagenomic data, which one of the currently three (soon to be five) tumor necrosis factor blockers has the greatest chance to get the Disease Activity Score to 2.6 without wakening red snappers from their slumber.
In its essence, personalized medicine is prototypically American. In a way that Joe the Plumber would like, personalized medicine is about the individual, and it is founded on the idea that optimizing the health of each and every individual will optimize the health of the nation.
Personalized Economics, Personalized Medicine
In his famous tête-à-tête with Barack Obama, Joe the Plumber discussed a related subject—personalized economics—querying the soon-to-be President-elect on the impact of taxes on his blossoming plumbing business. The discussion was very specific—indeed, downright personal—and involved a calculation to the last dollar as Obama elaborated on how much Joe would pay in taxes under his plan as compared to John McCain’s plan.