Thursday, December 26, 2013

Biomarkers' controversy in Medicine

As we see our volume of patients expand by overtaking other Doctor's business, there is this growing notion that we will be alright if we can stick to already defined standards of care, and make sure that patient main diseases have been monitored through current defined and recognized biomarkers.  Yet as an investigator, we live in an environment that we know to be in a transition to better biomarkers as modern medicine and technology continue to advance us rapidly.  As a physician, we are aware that disease biomarkers are very important in determining the cause of the disease that will initiate our patient condition, that some biomarkers will determine the disease status of activity, that some biomarkers will gives us the patient prognosis or clinical outcome in terms of disability or ultimately, fatality.   Level of patient participation in current recommended  prevention endeavors is held today by government institutions as a premier "biomarker" of patient's health.  Yes indeed across the country, the government is monitoring participation in immunization, glaucoma check, colonoscopy, mammogram and bone density screening for patients in defined age. The PSA (Prostate Specific Antigen) and rectal exploration for prostate size have sent us in a world of controversy because of the inadequacy in predicting Prostate cancers that really need to be screened!  Indeed, as it turned out, knowing that Prostate cancer is present is not enough because it is now clear that early detection did not give us clear and palpable benefit in survival.  That what happens when our biomarkers are insufficiently tested.  (new genetic biomarkers are in the work to come to the rescue).

Monitoring level of Testosterone and Vitamin D level has entered current practice and correction measures are being aggressively taken in a world of predominant frequency of cases of associated Hypertension without a clear balance of diseases' related risk.  To make the matter worse, our patients do not have have one single diagnosis.  Most patient carry up to 10 diagnosis to navigate in terms of clinical biomarkers...which biomarker set is important in each individual patient may be a matter of determinant symptoms or perception of medical risk for each individual patient and relevant clinical background as perceived by his doctor who uses insufficient standards of care but best under current circumstances and state of technology.

One area of Puzzling observation that need to be mentioned is the use of anti-inflammatory drugs.  Aspirin has entered the routine medical prevention....to be continued...
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