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#Health: Tailored medicine is not 'Taylor-made'

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DefiniensBigDataMedicine01Personalised medicine is a fast-moving field that sees treatments and medicines tailored to a patient’s genes, as well as his or her environment and lifestyle, writes Denis Horgab, Exectutive Director of the European Alliance for Personalised Medicine.

In a nutshell it aims to give the right treatment to the right patient at the right time, and can also work in a preventative sense. These cutting-edge sciences and 'omics' really hit the news last year when President Obama launched the Precision Medicine Initiative, earmarking millions of dollars to upgrade research, clinical trials and DNA sequencing in the US.

And the revolution is occurring on this side of the Atlantic, too. The Brussels-based European Alliance for Personalised Medicine (EAPM) and its multi-stakeholder membership are of the view that targeted, or tailored, treatments are the way of the future, will save lives and will improve the quality of life for an ageing population of 500 million potential patients across the EU.

The technology is marching on and seems unstoppable. For example, the human genome was first sequenced less than 15 years ago and took some serious time and even-more serious money. Today, the process takes a few hours and is relatively inexpensive, at around 1,000 dollars a time.  

As ever, big ideas often have to balance efficiency and cost. This is nothing new. The inventor of 'Taylorism', one Frederick Taylor, who lived at the turn of the 1900s, is known as the "father of scientific management". He was an expert in efficiency.

Taylor believed that the components of any task could be (and should be) studied, measured, timed, and standardised to maximise efficiency and, therefore, profit. He was an advocate of “the system over the man”. His beliefs spread quickly and widely with many companies, Toyota among them, successfully using his principles.

In a world in which populations are living longer and prices are sky-rocketing, the proponents of Taylorism will tell you that they like the idea of stopwatches in clinics to measure patient appointments. They argue that patient care should conform to the same ideas of 'value' that would apply to how long it might take a mechanic to affix a wing-nut, or a robot to spray-paint a new car.

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But can the standardisation that is so vital to Taylorism in, for example, a car plant, really be applied to medicine?

EAPM would argue not.

The bottom line is that personalised medicine is an innovative, efficient and patient-centred alternative to the outdated, outmoded and out-the-door one-size-fits-all treatment model. And its proponents will tell you that is also has the potential to yield a maximum return on healthcare investment - a strong argument for decision-makers in times of austerity.

OK, there is a 'value' issue and the great value debate needs to happen soon. Without doubt there are key questions about the cost-effectiveness of new and even existing treatments.

But there is a solid argument that value should be defined by the ‘customer’, in this case, the patient. And, as it turns out, the Toyota (et al.) manufacturing model does not work in many areas of medicine. We are not all the same. 

One-size-fits-all is a waste of money in a lot of cases, simply because it doesn’t work for a particular patient sub-group, for example. And there could be genomic issues, lifestyle issues and (unfortunately) access issues when it comes to patients, their diseases and their treatments.

And, anyway, to understand 'value' one must first understand a treatment and a medicine and consider what it can provide, weighed against cost and other considerations. 

When it comes to implementing personalised medicine there are still plenty of barriers. In Europe today, there are often circumstances in which some patients receive better care than others.

One of the issues could be described as guideline fatigue - it turns out that the best healthcare professionals are not necessarily those who doggedly follow each guideline, but are more likely to be those who prioritise their time.

Another could be a lack of patient power. Modern-day patients want empowerment, and to have their illnesses and the treatment options explained  in a transparent, understandable yet non-patronising manner to allow them to become involved in shared decision-making.

A third problem is an issue with end-of-life care. There is a growing perception today in Europe that patients often receive more care than they actually want. A step-up in doctor-patient dialogue should lead to end-of-life care that is much more matched to what the patient wants and needs. 

And a fourth is policy engagement. There is a need for much more of this to further the goals of EAPM and all stakeholders, which ultimately means getting politicians and civil servants to understand the value and societal benefits of personalised medicine. 

In tandem, there needs to be increased collaboration, not only between those in the same discipline but also between disciplines. 

There are many issues to contend with but, in the exciting and expanding world of personalised medicine, the patient should be king, not the system. 

Frederick’s philosophy may have been Taylor-made for Toyota. But it is certainly not tailor-made for modern medicine.

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