I have been reading about a new way to approach diseases and treatment.  A large amount of effort and resources will soon be directed by the biomedical research community toward the development of biomarkers for the identification of diseases and their progression so that we may develop tailored therapies against them.  Another effort entitled “stratified medicine” will be trying to target medicines and interventions according to biologic subgroups of patients.  Stratified medicine recognizes that not all patients respond to the same treatment for the same disease. It is hoped that between precision medicine and stratified medicine doctors can treat patients individually with the therapies that will work best for them.

The above approach sounds great, but it is going to take more than a few years for this to become a reality.  Insurance companies currently approve medications and some diagnostic tests from a cookie cutter, one treatment fits all, approach.  The new approach recognizes that patients may respond better to one medication than another for the same disease, and finding that out will take some tests which could be expensive.  Our office spends a good deal of time every day trying to find what medication is approved by a patient’s insurance company.  This medication has been put on the insurance formulary on the basis of cost and special deals with pharmaceutical companies.  What will happen when the formulary drug is not the right fit for a given patient?  Will we need to make more time consuming phone calls?