producing a well-fitted pair of pants. One would first have to measure and decipher the relevant biochemistry underlying the disease variation of that individual and then( if a well-fitted treatment is by coincidence not available) discover, develop, and monitor a custom drug in years of clinical trials( oh, and then be able to charge a few hundred million dollars per individual to recoup at least some of the clinical development costs).
Since we have not and are not able to develop individualized medicines, how bad is it really if we develop them instead for Mr. or Ms. Average- as in fact medical companies currently do? How many people are
average? And for those who are not average, will those medicines work?
Fortunately, data on this exact question already exist and the results are astounding- not in a good way. Let’ s look at the population performance of the top drugs in migraine, a classic example of a chronic disease with unpredictable but often devastating episodic attacks. What percentage of the population is effectively treated if you give them the drug in question?
What is astounding is that the best of the acute treatments is ibuprofen, but effective in only 1 in 3 patients. The best preventive treatment in chronic
Examples of top drugs marketed or in development in migraine and the portion of the population in which they are effective
Footnotes( a) 50 % responder rate; Vo P. et al. Cephalalgia 2017, Vol.
37( 1S) 319 – 374( b) Diener HC et al. Cephalalgia. 2007 Jul; 27( 7): 814-23( c) Dodick DW et al. Headache. 2010 Jun; 50( 6): 921-36( d) Tepper S. et al. Lancet Neurol. 2017 Jun; 16( 6): 425-434( e) Diener HC et al. J Neurol. 2004 Aug; 251( 8): 943-50.( f) Bussone G. et al. Int J Clin Pract. 2005 Aug; 59( 8): 961-8.
( g) Goadsby PJ, et al. N Engl J Med. 2017 Nov
30; 377( 22): 2123-2132( h) Headache relief at 2 hrs( i) Derry CJ et al. Cochrane Database Syst Rev. 2012 Feb
15; 2: CD008615.( j) Rabbie R et al. Cochrane Database Syst Rev. 2010 Oct
6;( 10): CD008039.
( k) Kirthi V et al. Cochrane Database Syst Rev. 2013 Apr 30; 4: CD008041.
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