Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

TRANSLATIONAL GENETICS

Going to the negative: genomics for optimized medical prescription

Abstract

Personalized medicine promises to advance and improve health by targeting the right medication to the right person at the right time, thus maximizing the proportion of treated patients who achieve an effective response to therapy. This Comment article makes the complementary argument that equally important benefits will derive from negative prediction, namely by identifying those individuals who are either not actually in need of, or unlikely to respond to, a drug. Reduction of unnecessary prescription could conceivably save health-care systems many billions of dollars with very little detrimental impact on outcomes.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

References

  1. Osterberg, L. & Blaschke, T. Adherence to medication. N. Engl. J. Med. 353, 487–497 (2005).

    CAS  Article  Google Scholar 

  2. Cook, R. J. & Sackett, D. L. The number needed to treat: a clinically useful measure of treatment effect. BMJ 310, 452–454 (1995).

    CAS  Article  Google Scholar 

  3. Sparano, J. A. et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N. Engl. J. Med. 379, 111–121 (2018).

    CAS  Article  Google Scholar 

  4. Mega, J. L. et al. Genetic risk, coronary heart disease events, and the clinical benefit of statin therapy: an analysis of primary and secondary prevention trials. Lancet 385, 2264–2271 (2017).

    Article  Google Scholar 

  5. Natarajan, P. et al. Polygenic risk score identifies subgroup with higher burden of atherosclerosis and greater relative benefit from statin therapy in the primary prevention setting. Circulation 135, 2091–2101 (2017).

    Article  Google Scholar 

  6. Vallejo-Vaz, A. J. et al. Low-density lipoprotein cholesterol lowering for the primary prevention of cardiovascular disease among men with primary elevations of low-density lipoprotein cholesterol levels of 190 mg/dL or above: analyses from the WOSCOPS 5-year randomized trial and 20-year observational follow-up. Circulation 136, 1878–1891 (2017).

    CAS  Article  Google Scholar 

  7. Kugathasan, S. et al. Prediction of complicated disease course for children newly diagnosed with Crohn’s disease: a multi-centre inception cohort study. Lancet 389, 1710–1718 (2017).

    Article  Google Scholar 

  8. West, N. R. et al. Oncostatin M drives intestinal inflammation and predicts response to tumor necrosis factor-neutralizing therapy in patients with inflammatory bowel disease. Nat. Commun. 23, 579–589 (2017).

    CAS  Google Scholar 

  9. Abraham, J. Pharmaceuticalization of society in context: theoretical, empirical and health dimensions. Sociology 44, 603–622 (2010).

    Article  Google Scholar 

  10. Brigham, K. & Johns, M. E. Predictive Health: How We Can Reinvent Medicine to Extend Our Best Years (Basic Books, NY, 2012).

    Google Scholar 

Download references

Acknowledgements

G.G. is grateful to the Fulbright Program of the Bureau of Educational and Cultural Affairs of the United States Department of State, administered by the Institute of International Education, and to the College of Sciences of Georgia Tech for sabbatical support in Fall 2017, and especially to A. Navarro and J. Bertranpetit (CEXS-UPF in Barcelona) and L. Waller (Emory) for discussions.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Greg Gibson.

Ethics declarations

Competing interests

The author declares no competing interests.

Additional information

Related link

The NNT: http://www.thennt.com

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gibson, G. Going to the negative: genomics for optimized medical prescription. Nat Rev Genet 20, 1–2 (2019). https://doi.org/10.1038/s41576-018-0061-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41576-018-0061-7

Further reading

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing