{"id":8077,"date":"2011-04-25T00:02:30","date_gmt":"2011-04-25T04:02:30","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=8077"},"modified":"2011-04-25T16:46:40","modified_gmt":"2011-04-25T20:46:40","slug":"personalized-medicine-prequel-to-an-epilogue","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2011\/04\/25\/personalized-medicine-prequel-to-an-epilogue\/","title":{"rendered":"personalized medicine: prequel to an epilogue…,"},"content":{"rendered":"
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In those sleepy afternoon World History classes, I used to wonder if the people in the empire of this week knew that they were just a chapter away from obscurity. We never talked about them very much [the people] – just their Kings. Years later, when we lived in Europe and saw those castles and the battle-fields, they were peaceful. They didn’t seem to have much to do with the lives of the people on the streets. Tourists gawked, but the locals didn’t even look up as they hurried by. I grew up on the scene of a fierce battle in the Civil War with cannons, monuments, and plaques everywhere – but they were things to climb on for whatever reason kids climb on things. It never occurred to me to wonder if the soldiers memorialized there knew their moment would slowly drift into world history – important maybe, but forgotten.<\/p>\n

Should I have started my chart with Thorazine, and added all the neuroleptics [whose differences mattered so much when I was a resident but are now forgotten]? or the tricyclic antidepressants? the benzodiazepines? When did it start, this Age<\/strong> I’m trying to define? I think it actually began with the DSM III<\/font><\/strong> – though, of course, there is a history of the why<\/em> of the DSM III<\/font><\/strong> too. And what will we call it, this Age<\/strong> that’s not yet ended? Might it be called the Age of Psycho-Neuro-Pharmacology<\/strong> [from the literary titles of the era, the Age of Emerging-New-Psycho-Neuro-Pharmacology<\/strong> seems more appropriate]. I doubt that the framers of the DSM III<\/font><\/strong> would’ve seen it as the beginning of an Age of Emerging-New-Psycho-Neuro-Pharmacology<\/strong>, any more than the personalized medicine<\/font><\/strong> aficionados see themselves as ushering in an ending, but that’s the way it seems to be playing out. <\/p>\n

As we learned from the Model A Ford<\/font><\/strong>, you can only soup up a car so much – then it’s time to move on. After a decade of glory competing for who had the most SSRI<\/strong>-ish SSRI<\/strong> and it dawned on us that their potency was disappointing, the move to soup them up began in earnest. There was Augmentation<\/strong><\/em> [Lithium, Thyroid, Atypical Antipsychotics, other SSRIs, SNRIs]. That was followed by Sequencing<\/strong><\/em> [STAR*D<\/font><\/strong> – something of a bust by my reading]. Recently there’s been Doubling-Up<\/strong><\/em> [CO-MED<\/font><\/strong>, coming soon to a journal near you]. The next thing on the agenda is personalized medicine<\/strong><\/em>, exemplified by iSPOT<\/font><\/strong> [it strikes me as similar to the word "customizing" as it was used in the world of 1950 "hot-rods"]. As we were told at the American Psychiatric Association meetings last May:<\/div>\n