Much of this approach, says Barber, is down to the way modern society views illness. \u201cWe\u2019re treating the disease, not the patient,\u201d he says. \u201cPlus, most technologies develop because of feedback from the user: For example, they improve a car model every five years and regularly update the software on our phones. But you don\u2019t have that feedback loop with medicines because in the end the sale is to a health system.\u201d<\/p>\n
Why pills don\u2019t always work wellThey are off the peg, not bespoke<\/p>\n
Before drugs come to market, they go through exhaustive rounds of clinical trials, but these don\u2019t take into account a person\u2019s sex, age, or genetic make-up.<\/p>\n
Historically, medical trials were conducted mainly on men. \u201cThere was an assumption that women and men weren\u2019t that different, but then we had incidents like the appalling thalidomide tragedy,\u201d says Barber, referring to a drug that decades ago was mistakenly viewed as safe during pregnancy before later being found to cause birth defects. \u201cEven these days, it can be hard to recruit people to trials, but that\u2019s even more of a reason to include women, as they\u2019re not a rare species on the planet.\u201d<\/p>\n
The difference matters, because women may metabolise drugs more slowly than men \u2013 meaning the medication stays in their system for longer \u2013 or they may react in a certain way depending on where they are in their menstrual cycle.<\/p>\n
Factors such as body size, genetics, liver or kidney function, and the interaction with other medications can also have a big impact. According to Barber, the future lies in creating a more personalised prescription model based on an individual\u2019s specific make-up. There are already trials taking place in this area, which is known as pharmacogenomics.<\/p>\n
Drugs like statins may not be worth taking<\/p>\n
\u201cWhen we\u2019re discussing whether a drug works, it depends on what you mean by \u2018works\u2019,\u201d says Barber. \u201cA statin, for example, will probably lower your cholesterol. But the reason you\u2019re being given a statin is because you want to avoid a heart attack or stroke.\u201d<\/p>\n
If you\u2019re reasonably healthy, says Barber, and have no risk factors other than the fact your lipids are raised, \u201cthen perhaps, for every 100 people who take a statin for 10 years, one person will avoid a stroke or heart attack.<\/p>\n
\u201cSome people still think this is worth it \u2013 they really don\u2019t want a heart attack or a stroke, even if it\u2019s a one-in-100 chance. It\u2019s like a fire insurance policy on the house: You\u2019re probably never going to claim it, but you\u2019re happy it\u2019s there.\u201d<\/p>\n
Barber emphasises that the more risk factors you have, such as a family history of cardiovascular disease, high blood pressure \u2013 as well as being older \u2013 the more you are at risk and the more likely it is that the drugs will make a difference. \u201cSo these things have to be taken into account,\u201d he says.<\/p>\n