Yes, I’m behind in my reading. That’s why I’ve just noticed that the October 2007 edition of Harvard Business Review includes a provocative article titled “Realizing the Promise of Personalized Medicine,” by which the authors, Mara Aspinall and Richard Maermesh, mean treatment tailored to an individual’s genetic profile. The argument for this type of treatment is that it will save lives and save dollars. It will save lives because it will shorten the trial-and-error process by which doctors try to find the best treatments for patients, trying this, trying that, in a process in which acutely ill patients may either die before an appropriate treatment is discovered or die from adverse reactions to the treatments tried first. It will save dollars because it will reduce the amount of money spent on treatments that don’t work at all for large groups of patients.

Sounds good. But what’s in the way? The authors identify four barriers: (1) the pharmaceutical industry’s historically successful blockbuster model for drug development, (2) a regulatory environment that devotes too many resources to phase-three clinical trials and too few to monitoring and assessment after a drug is approved, (3) a dysfunctional payment system that reward physicians for activity (completing procedures and prescribing drugs) instead of early diagnosis and prevention, and (4) physician behavior whose habits are rooted in the traditional trial-and-error approach.

Overcoming these barriers won’t be easy. Look for the pharmaceutical industry to behave like the movie industry, which is also threatened by long-tail alternatives to producing blockbusters. Don’t count on regulators, already overstretched by the testing required to approve drugs to take on the additional burden of follow-up monitoring and assessment. Don’t count on physicians (and pharma, too) to reduce their income streams. Don’t count on physicians to change their habits or medical schools to adapt quickly to necessary changes in medical education. The authors suggest that these changes are possible. Me? I see a strong case for political, a.k.a., government intervention. I won’t deny that in the long run the market may sort this out. As Keynes noted, however, in the long run we are dead.