An Inconvenient Truth

Abstract

See related article, pages 1286–1294 In his essay entitled The Uniqueness of the Individual , published in 1957, the Nobel Laureate Peter Medawar described how the tremendous genetic diversity of individuals within a species enables the species as a whole to survive.1 At same time, his essay highlights that individual genetic diversity also poses a major challenge for the medical profession when trying to treat individuals. Although Medawar focused on genetic immunologic diversity in the context of immunologic tolerance to enable therapeutic transplantation of tissues and organs, the basic concept of diversity being a major benefit as well as a challenge is applicable to all aspects of human existence, from artistic creativity to social structures. In medicine, the recognition of the importance of individual diversity is common-place and has been incorporated into the day-to-day practice in the field of transplantation medicine and immunology. More recently, it is gaining recognition and acceptance in other fields of medicine as well and has given rise to the concepts of pharmacogenomics and individualized medicine, in which medical therapies would be tailored to the specific gene expression and drug-response profile of the individual patient.2 Genetic profiling of patients is rarely performed in the practice of cardiovascular medicine, but data are emerging that, for example, patients may differ in their responses to drugs such as aspirin, although there is significant controversy in this area.3 Even in emerging cardiovascular therapeutic approaches, such as those directed at enhancing blood vessel growth, there is a lack of standard patient profiling and individualizing therapies. One major reason is that many underlying mechanisms of blood vessel growth and interindividual differences in blood vessel growth are still …