A thriving trend in marketing and manufacturing is the oxymoronic concept, mass customization. Put your dog's picture on your credit card, your own message on M&M's, even design your own perfume and clothing. This concept won't be coming to medicine any time soon.

The nature of the physician/patient interaction is all about understanding the needs of the specific patient and choosing the treatment most likely to bring about a desired outcome. But physicians' options in some areas of medicine are still relatively off-the-rack.

Take glaucoma surgery. The last decade has seen a veritable explosion of options—from one. The new additions have changed the way surgeons think about their options from the former "Lord of the Rings" mentality (one ring to rule them all), as one of our experts describes it this month.

The hope for customization in medicine is, however, alive and well at least in the research stages.

In the May 1 issue of The Lancet, Stanford and Harvard scientists report successful proof-of-concept of "whole genome sequencing," or analyzing a patient's full genome for disease risks and unusual drug responses.1 They evaluated the entire genome of a 40-year-old man and compared it to several databases of disease-related gene variants, factoring in the patient's medical and family history and statistical disease risks. The analysis revealed variants associated with diseases in the man's family and with conditions not in his family. Some variants suggested that he might have unusual responses to certain heart medications, which was meaningful in light of his risk for cardiovascular disorders.

The authors believe their work supports the concept that whole-genome sequencing might one day play a clinical role.

Even as the understanding of genetics expands, researchers long ago moved past genes as a singular determinant of health. This week, epigeneticists (who study how environment affects the genetic code) at the Linus Pauling Institute at Oregon State University reported progress in their work on the role that metabolism and certain foods may play in cancer cell apoptosis.

We're obviously a long way from truly personalized medicine. (Unfortunate nomenclature: Medicine has always been personal; what's more personal than entrusting the care of your body or your vision to another? It's the remedies that need to be personalized.)

But, no matter. As our cover story this month describes, the days of one ring to rule them all are numbered.


1. Lancet, 2010:375:1525-1535.