I first came across medical ethicist Professor Donna Dickenson at the 2012 Literary Festival and quickly added her to my list of favourite science communicators. I was delighted, therefore, to be part of an unusually large (for a science talk) audience at the Martin School on Friday afternoon to hear her discuss some of the topics covered in her latest book, Me Medicine Vs. We Medicine.
Professor Dickinson opened with a picture of Prince Albert: a striking reminder that, until the mid 20th century, the big killers were infectious diseases such as TB, influenza and typhoid (which did for the Prince in 1861) and that they were no respecters of wealth or class. These infectious diseases were seen very much as communal problems and so the public health measures and medical developments that made them rare and treatable benefitted everyone. This is what Professor Dickenson calls "we medicine".
These days, the biggest, and most feared, killers in the West are individual diseases such as cancers and heart disease. The solution, according to some, is "me medicine" - personalised medicine (pharmagenetics) which takes account of a patient's genetic type or even the genetic profile of an individual cancer. Potential benefits of pharmagenetics might include lighter doses, quicker responses to treatment and reduced side effects. However, Professor Dickenson was quick to remind the audience of the need for caution. Whilst pharmagenetics undoubtedly had a place in the future of medicine, it may not be the "magic bullets" of press hype: for example, cancer may give rise to different genetic mutations at different sites in the same tumour.
And even if pharmagenetics is all it’s cracked up to be, will it give rise to new ethical questions? Is the drive to promote genetically tailored drugs being driven by drug companies as part of a new business strategy, or the narcissistic cult of the individual? Is the development of treatments that benefit the few and not the many a fair use of limited resources? How do you choose between the competing claims of different groups of patients?
Me Medicine Vs. We Medicine was a clearly presented introduction to a whole raft of issues that may soon face us all, both as individuals and as members of society. The venue, a well-equipped modern seminar room in the Martin School (the former Indian Institute) was ideal for both the presentation and the thoughtful question and answer session that followed.