His new book's title might suggest otherwise. But Lee Gutkind, co-author of An Immense New Power to Heal: The Promise of Personalized Medicine, remains only "cautiously optimistic" about how the sequencing of the human genome can improve health care.
Gutkind is the Pittsburgh native and veteran nonfiction author of works including Many Sleepless Nights, about organ transplantation. The new book, which Gutkind co-wrote with Pagan Kennedy, uses stories of doctors and patients to map the state of the art. But it begins by recalling the fanfare surrounding President Clinton's 2000 announcement of that historic sequencing. That the breakthrough would revolutionize medicine seemed inevitable.
Indeed, genomic medicine — which is encompassed by the broader term "personalized medicine" — has already produced treatments including the breast-cancer drug Herceptin. And there are gene-based diagnostic tests, like Oncotype DX (which predicts whether chemotherapy will work on a particular breast tumor).
Meanwhile, the idea of medicine made not for everyone, but for particular patients, has even inspired UPMC to announce plans for a $300 million Center for Innovative Science, with a focus on personalized medicine.
But Clinton's speech that day in 2000 — which provides the new book's title — foretold a bullishness on genomic medicine that Gutkind considers premature. As Gutkind characterized such expectations in a recent phone interview, "We'll figure out what genes cause what diseases, and deal with the genes: We'll annihilate them or we'll plan in advance — if you have the cancer gene, we'll figure out how to get rid of the cancer gene."
But such expectations are "something greater than could possibly be achieved," says Gutkind.
"For one thing, there are very, very few genes, a single gene, that leads to a single disease," he says. "Very often [it's] a combination of 12, 30, 40 or a hundred different genes that get you there." So knowing how one gene works, by itself, often is medically insufficient.
Moreover, while the amount of new information gene-sequencing has created is indisputably vast, knowing what that information means is a different matter. As Gutkind notes, "We haven't even catalogued the information." And there is also much more to learn about how genes behave in the presence of both environmental influences (pollution, say) and human behavior (like diet and exercise).
All in all, says Gutkind, the genomic revolution "may be a miracle, but it's a miracle that it's going to take half a century to make."
Yet there are aspects of personalized medicine that can make a difference today, says Gutkind, who now splits his time between Arizona (where he teaches) and Pittsburgh (where he runs the Creative Nonfiction Foundation, whose In Fact Books imprint published Immense New Power). They're just not the aspects that get the most attention.
Gutkind argues that our health-care system — from doctors to insurers — needs to focus more on preventing and diagnosing disease, rather than just treating it. Part of that involves low-tech, time-intensive techniques like doctors interviewing patients to get detailed family histories, to help learn what their health risks are. Patients have to be more proactive too, paying attention and asking questions rather than just following doctor's orders.
It's in a prevention-minded, up-close-and-personal health-care setting, Gutkind says, that even something like your genetic profile will be most valuable.
"This whole revolution has got to begin ... with the partnership between the patient and the physician," he says.