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Essay
Personalized Medicine's Ragged Edge “Success” may produce problems.

The phrase “personalized medicine” has a built-in positive spin. Simple genetic tests can sometimes predict whether a particular individual will have a positive response to a particular drug or, alternatively, suffer costly and debilitating side effects. But little attention has been given to some challenging issues of justice raised by personalized medicine. How should we determine who would have a just claim to access particular treatments, especially very expensive ones? How effective do those treatments need to be?

If there were a thick, bright line separating minimal responders from maximal responders, then we could allocate these treatments in a fair and cost-effective way. But there is no bright line. The reality is more like a ragged edge—some people will clearly benefit a lot, some people will clearly not benefit at all, and many people will benefit somewhat. 

The phrase “personalized medicine” has a built-in positive spin. Simple genetic tests can sometimes predict whether a particular individual will have a positive response to a particular drug or, alternatively, suffer costly and debilitating side effects. But little attention has been given to some challenging issues of justice raised by personalized medicine. How should we determine who would have a just claim to access particular treatments, especially very expensive ones? How effective do those treatments need to be?

If there were a thick, bright line separating minimal responders from maximal responders, then we could allocate these treatments in a fair and cost-effective way. But there is no bright line. The reality is more like a ragged edge—some people will clearly benefit a lot, some people will clearly not benefit at all, and many people will benefit somewhat. 

Leonard M. Fleck, "Personalized Medicine's Ragged Edge," Hastings Center Report 40, no. 5 (2010): 16-18.