Will pharmacogenomics disrupt the U.S. health care system? No

There is a widely held view that the scientific breakthroughs represented by pharmacogenomics and other new biomarkers portend a new 'personalized medicine' that will disrupt and revolutionize the U.S. health care system. This paper explores this hypothesis, arguing that while this exciting new science will enhance our understanding of human biology and our ability to develop new measures against disease over the long term, there is little reason to expect it to undermine or fundamentally alter the current U.S. health care system. This system is under attack from other, broader societal forces and will necessarily change; however, the argument made here is that the current system can easily cope with the changes that pharmacogenomics will bring and that it is unlikely to be disruptive to the current system because (1) it will probably unfold gradually and incrementally over a time span of decades and (2) our drug development and health care system--from development to delivery--has demonstrated sufficient flexibility to adapt to these kinds of incremental changes. Nonetheless, the sustainability of the projected growth in health spending is in question. Profound reforms are likely, but improved knowledge of our human biology will more likely be a constructive factor as we adapt to these changes.