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Yet the ultimate message of genomics is that one size (of drug) does not fit all, which contradicts the basic philosophy that drives blockbusterdom. The fact is that each gene has polymorphisms-variations (or alleles) on the standard-issue gene.Many of those variations are expected to correlate with disease states, but even so, not all the variations are likely to respond to the same drug. The irony of genomics is that the more precise the science, the smaller the potential market may be.

You don’t have to be a Bolshevik to understand that “customized medicine” are fighting words in the traditional economy of drugs. They take the mass out of mass market, and remove scale from economies of scale. I have seen biotech executives recoil at the prospect of developing a drug that would benefit “too few” people.

In the long run, a company that develops a broad portfolio of “modest” drugs-as in annual revenues of $300 million to $500 million-may do just as well as a company that continually searches for a blockbuster. Lip service is already being paid to the argument that customized, genomics-based drugs will be more effective and come with fewer side effects, and therefore will be able to attract a significantly higher price.

That may be. But here is a modest cautionary note: For 10 years, scientists have been selling the genome project to the public on the basis of the way it will revolutionize medicine. If, because of the blockbuster mentality, a lot of genomically based drugs do not get developed simply because the market looks too small, or if these new drugs are even more stratospherically priced for consumers, you may hear a public outcry that will make the current debate over the cost of prescription drugs sound like the balcony scene between Romeo and Juliet.

It will be fascinating to see how the pharmaceutical industry handles the glut of possibility in the era of the genome. After you’ve seen a single drug literally transform the landscape of your R&D campus, it’s easy to understand the allure of the blockbuster syndrome. To mix drug metaphors here, it may be hard for Big Pharma to kick the habit.

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