Pharmacogenomics and personalized medicine: mapping of future value creation.

PERSONALIZED MEDICINE People have been talking about personalized medicine, to a point that it almost gets old. Some are firm believers in this revolution and are actively devoting effort to advance it, others wonder whether this is yet another hype, and yet many others may have an impression that, as promising a future as it paints, it may only become reality in another lifetime. Regardless, most people seem to agree that personalized medicine is the trend of future. Correspondingly, just like any other major social/technological transformations in the world, it would bring along great value creation and reallocation among various stakeholders in the healthcare industry. Given its fundamental impact and implications on all different businesses related to healthcare, it is critical for senior management in the healthcare-related industries to have (or at least start to consider) a clear understanding of where the future value will lie, when it is coming, and how to best prepare the organization to capture the most value in this revolution. Personalized medicine addresses current unfilled needs in the healthcare world by calling for the right treatment for the right individual at the right time. In current drug therapeutics world, it is widely observed that a drug doesn’t work for all the patients all of the time. Drugs do not have the desired outcome in 30%–40% of patients, blockbuster drugs are often efficacious in 40%–60% of the patients, and it is not unusual to see chemotherapy working for only 30% of cancer patients (from industry expert interviews, the American Medical Association; www.ama-assn.org/ama/pub/ category/7459.html). In addition, drugs can at times cause adverse drug reactions (ADRs), with some more severe than others. There are different levels of variation among individuals (Figure 1) that could account for the varying outcomes of drug therapy, such as patients’ different drug absorption, distribution, metabolism, and excretion (ADME) profiles measurable at organ, tissue, or cellular levels and more fundamental differences at molecular levels, [i.e., analyses of protein, RNA (gene expression analysis), and DNA (genotyping)]. Genotyping and gene expression analysis are current key component technologies of pharmacogenomics (PGx) that currently serves as the major driving force for the personalized medicine revolution.