Abstract
BackgroundIn precision medicine biomarkers stratify patients into groups that are offered different treatments, but this may conflict with the principle of equal treatment. While some patient characteristics are seen as relevant for unequal treatment and others not, it is known that they all may influence treatment decisions. How biomarkers influence these decisions is not known, nor is their ethical relevance well discussed.MethodsWe distributed an email survey designed to elicit treatment preferences from Norwegian doctors working with cancer patients. In a forced-choice conjoint analysis pairs of hypothetical patients were presented, and we calculated the average marginal component effect of seven individual patient characteristics, to estimate how each of them influence doctors’ priority-setting decisions.ResultsA positive biomarker status increased the probability of being allocated the new drug, while older age, severe comorbidity and reduced physical function reduced the probability. Importantly, sex, education level and smoking status had no significant influence on the decision.ConclusionBiomarker status is perceived as relevant for priority setting decisions, alongside more well-known patient characteristics like age, physical function and comorbidity. Based on our results, we discuss a framework that can help clarify whether biomarker status should be seen as an ethically acceptable factor for providing unequal treatment to patients with the same disease.
Highlights
In precision medicine biomarkers stratify patients into groups that are offered different treatments, but this may conflict with the principle of equal treatment
Tranvåg et al BMC Med Ethics (2021) 22:55 factor receptor (EGFR) in lung cancers [10], expression of erb-b2 receptor tyrosine kinase 2 (ERBB2, known as Human epidermal growth factor receptor 2 (HER2)) in breast cancer [11], B-Raf proto-oncogene (BRAF) mutations in melanoma [12], and expression of the Cluster of differentiation 274 (CD274) molecule known as Programmed death-ligand 1 (PD-L1) expression in various cancer types [13, 14]
Biomarker status produced the third largest effect of the patient characteristics in the experiment: a patient aged 87 years has a 47 pp reduced probability of being allocated the new treatment compared to a patient aged 63, and a patient with severe comorbidity has a 26 pp reduced probability of being allocated the new treatment compared to a patient with no comorbidity
Summary
In precision medicine biomarkers stratify patients into groups that are offered different treatments, but this may conflict with the principle of equal treatment. Stratification of patient groups into smaller subgroups or single patients is a hallmark of precision medicine, but may be perceived as discriminatory against other patients in the same group Such practice may challenge common sense morality and the principle of formal equality, which requires equal treatment to patients that are equal in all ethically relevant aspects [1, 2]. The development of precision medicine has brought great promises [7] and by tailoring diagnostics and treatment to individual patients, the overarching motto of precision medicine can be achieved: “The right drug to the right patient at the right time” [8] This belief is especially developed in oncology, where an increasing number of new targeted therapies are given only to a small selection of patients based on biomarkers [9]: examples are mutations that lead to upregulation of epidermal growth. We were interested in how biomarker status was perceived in relation to more traditional patient characteristics such as comorbidity and age
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
