oa Editorial

The cost of health care is ever increasing and absorbing larger portions of national budgets. This issue has recently come into sharp focus in the United States with the debates on health care reform. Other countries are not immune from this issue. Those that have comprehensive health care systems are struggling with ever increasing cost, and many countries with more limited resources are trying to find ways to deliver even basic health care. There are many reasons for the escalating costs of health care, and if solutions are to be found, they will likely take many forms. One “problem” with health care is that many of the drugs we use are intended for wide patient populations, with the thought that if it does not work; physicians and patients will switch to something else. For patients who respond, this approach works well, but for those who do not, it leads to delay in therapy, adverse reactions without benefit, and a waste of money. One of the potential “ solutions” to this predicament is targeted therapy. This is not a new concept, and was certainly a goal of pharmaceutical development long before the current debate on healthcare. In almost every disease and therapy, there are some patients who respond, and some who do not; some patients who tolerate the therapy, and others not. The goal is to identify patients who are most likely to benefit with the lowest risk of adverse drug reactions. In some areas, especially chemotherapy, there have been marked successes in getting the right drug to the right patient. In other areas, success has been more limited, largely because understanding of the pathophysiology of disease is more limited, or it is not clear how and why patients differ in their responses. The reasons for these differences in response and tolerability appear to be largely related to genetics, although environmental and cultural factors may also play a role. As we understand more about the interplay between genetic variability in health and disease, we will be in a better position to target drugs to disorders in specific patients, rather than entire populations. What does this have to do with Current Drug Therapy? Even in this issue and we can expect more and more in the future, we will see articles describing therapies for selected groups of patients and individuals with clearly defined characteristics, thus delivering the right drug to the right patient.