Evidence based medicine vs personalised medicine

Some interesting comments on evidence based medicine from this Malaysian doctor. And isn’t the BHRT we get from compounding pharmacies is something like the ‘personalised medicine’ described here?

(Bolding by HCS)

Dr Rizin H Kusop. MBBS, MSc (Anti-Aging, Regenerative and Aesthetic Med), Dip. Family Med

From the website of  Society for Advancement of Hormone & Healthy Aging Medicine Malaysia (SAHAMM)

You may have heard what ‘evidence based medicine’ is all about. This is especially true if you are very inquisitive about your illness and health. Some doctors will also spell this out (including me) in trying to explain certain treatments for your illnesses.

Evidence based medicine is a concept where only practices which has been proven beneficial in majority of patients in the past are chosen to be practiced on you, the patient. It means a treatment is now being given to you because it has been proven to work in the past on majority of patients. If you are behaving like ‘majority of the patients’ then the treatment should work on you too.

Unfortunately there is no single treatment or practice which is considered working effectively on all patients at all time. The key concept of evidence base medicine is, if it works on some ‘statistically significant’ percentage of people then it may work on all people too. Another way looking at it is, if it works on most people, it should works on you too! Now both you and me know that those concepts are at best, oversimplified and at worst, simply not true. We are unique individual.

Then comes the personalised medicine which you may never heard before. Personalised medicine is a concept which treatments or practices are tailored only for you and no one else. This is where your doctor tries to work out the best treatment and management for you which may not be applicable to others. Unfortunately, this concept is still in its infancy. The doctor trained in this field would have to get to know you better than you know about yourself. One of the key concepts in this practice is for the doctor to do a genetic profile on you and work from there to see what medications, diets, exercise regimens and supplements optimise your health.

For example, if you have high blood pressure, the genetic profiling will reveal if one class of drug is effective to lower your blood pressure and the other class may be absolutely useless. Similarly, genetic profiling will tell if weight lifting exercise or aerobic exercise makes you lose weight. Genetic profiling also will tell if you need Statin or only vitamin B12 and folate to lower your cholesterol.

These variations are due to defects in our genes which can be detected by reading the sequences of DNAs. Often the variation is caused by a single change in the long series of DNA sequences. The variation is named as ‘Single Nucleotide Polymorphism’ or SNP (pronounced as snip). There are just too many SNPs in human body that there are probably no two similar human beings exist at the same time.

Of course, the genetic profiling test comes with its own cost and knowledge to interpret. It will be quite a while before personalised medicines makes it way to main stream medicine. Meanwhile, it make sense for you to take your health personally and understand that some conventional treatments may not work for you.


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Posted in Bioidentical Hormone Therapy Overseas, Evidence Based Medicine, Mainstream Medicine.

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