Making personalized medicine more affordable.

Precision medicine holds promise to solve the conundrums of clinical care. Foremost is the well-known but vexing problem of heterogeneity and the tyranny of the mean. Who will respond to a treatment? How can patients avoid the harms of treatments that will not work for them? And if we know who to treat, will that make care more efficient and less costly? But the converse can also be true: treatments become more expensive as the costs of development must be distributed across smaller populations. Next-generation sequencing is making genetic testing radically cheaper. But the costs of medical tests also include false-positive results, incidental findings, and the cascade of follow-up. The affordability of precision medicine is intertwined with the broader issue of affordability of our healthcare system, and will require all stakeholders to assume stewardship for access and sustainability.