Too Much Optimism at the NIH? →
Neil Greenspan’s argument that Collins is too extreme in optimism is fallacious. The examples given do not paint a picture of an unsound scientist. Frankly, the examples are weak. To suggest, as this article does, that Collins does not understand the current limitations of personalized medicine is laughable.
Greenspan provides as an “illustrative” example the case of Abacavir.
“An illustrative case is provided by the anti-retroviral drug, abacavir, used to treat AIDS. Abacavir causes a dangerous hypersensitivity reaction in patients with a particular gene involved in immune responses. However, based on recent studies, only about 55% of the individuals with the relevant gene are expected to exhibit the undesirable response on exposure to the drug (8, 9). Therefore, as many as 40-45% of those testing positive for the gene, and who could potentially use the drug safely, will receive an alternative agent. In other clinical situations, there may not be so many alternative agents of comparable effectiveness so that the inefficiency in such a genetic test, even if justified on balance, could incur its own costs in non-optimal treatment.”
This case is hardly the illustrative example to drive his point home that Collins is too optimistic. Without the genetic test to determine which patients can safely tolerate Abacavir, the drug would not be on the market, period. So what difference does it make whether or not there are alternative treatments? If there are alternatives to Abacavir and a patient cannot tolerate this drug, then the alternates should be considered. If there are no alternates, then the genetic test will at the very least allow some patients, those who can tolerate the drug, to use the only option.
Furthermore, Greenspan provides examples as if there is insufficient headroom for scientific progress to birth the promise of personalized medicine. Perhaps he is too pessimistic? Bottom line for me is that I prefer a visionary rather than a rank-and-file scientist leading the NIH.
