It is cancer that the problem is most acute

It is a very effective drug. Unfortunately, it is not made for you. You do not have good genetic profile. "Going to have to get used to this kind of judgment by the medical profession. Imagine the first reaction of the patient shaken by this diagnosis without appeal: "This is social security to save money."Little by little, the personalized medicine yet enters hospital morals. The idea is not new. Doctors always know that we are not all equal to the disease. The lucky have a robust body, while others are more fragile. It goes same with drugs. Some patients react positively to a molecule, whereas others feel no effect or, worse, develop serious side reactions. With combined breakthrough of genetics and molecular biology, personalized medicine became the star of all medical Congress within ten years.

This concept is based on a very powerful tool: genetic diagnosis. DNA Microarrays are today the best technique to detect more or less deleterious mutations in our chromosomes (read below). The cost of these analyses continues to fall and soon this diagnosis will be part of the hospital routine. The cancer is very advanced in this individual approach, but the Rheumatology and autoimmune diseases he followed suit. "Most old drugs, such as gold salts, fell to oblivion with the arrival of the anti-TNF alpha", explains Professor Thierry Schaeverbeke, CHU de Bordeaux Rheumatology service. "More finely studied the immune system of these diseases and inflammatory reaction, more it identifies new targets," says this expert.

Combinations of mutations

Regularly, researchers discover original combinations of mutations which uncover played disparities as terrible injustices experienced by patients. Last week, a team of researchers from the Institute Gustave-Roussy highlighted a specific mutation in the breast cancer explaining the poor responses to chemotherapy administered to some patients. The biological test corresponding development is expected to isolate the carriers of the "good mutation."

The medical world uses a term just committing to qualify these lucky patients: "good answering machines. The pharmaceutical industry uses a formula much more happy to describe the new deal: the stratification of patients. Thirty of these targeted drugs are currently available to treat cancers. Most of the time, these "smart" molecules are biotechnological production processes. Reverse of the Medal, their price heights and their cost-effectiveness is often challenged by public health experts, who are not their account (see box below).

Pierre Bey, the Director of the Hospital of the Curie Institute in Paris, is very concerned by this inflation. "Effective care, the needs and requirements increase faster that resources." "Budgetary constraints will inexorably grow", feared the doctor, but recognizes the need to "prioritize, regulate and prioritize" care, only strategy to try to curb this "inflationary spending." At the same time this cancer specialist who fervently defends the French model of access to care is a question that sums up the complexity of the problem. "What doctor will decide not to expensive and authorized drug for budgetary reasons."In other words, the policy can not discard their responsibilities in authorizing the placing on the market of innovative medicines with one hand and accusing other physicians to use permanently.

"Expensive molecules".

It is cancer that the problem is most acute. The first molecule targeted date of 1998. Since then, this class of drugs has continued to grow. Thirty of these treatments, such as the average cost approaching or exceeds 50,000 euros per year and per patient, are already on the market, and both are in the pipeline of the laboratories. The curves established by Curie Institute confirmed the dizzying evolution of expenditure "expensive molecules", which have nearly quadrupled since 2001.

Shown the finger by all actors, the pharmaceutical industry is justified by putting forward economic criteria. "The discovery of new molecules becomes very complicated." "The cost of development of a new class of drugs approaching now the $ 4 billion," says the CEO of the Swiss group Novartis Daniel Vasella. "I do not wish to live in England, where these drugs are in fact rationed", adds the pattern of the Basel group. Development budgets rising on one side and patients more reduced the other populations. From an accounting point of view, the result was accrued in advance.

The President of the Inserm, André Syrota, expected him also much of this new discipline, but for all other reasons. "Personalized medicine is an industrial activity emerging." In the national debt that will be launched soon, the National Alliance for life and health sciences will announce a major research project. We will involve all major research institutions working in health: Inserm, CNRS, the CEA and Inria.