A “note on the desk” left by US President George W Bush’s Health and Human Services Secretary Michael Leavitt for President-elect Barack Obama tells him that the promise of personalised health care is “central to the future of healthcare.”

The potential for personalised techniques to improve health and increase value make it not a niche concern but a factor that should be targeted as part of any plan to reform the nation’s health care system, writes Sec Leavitt. He also warns the incoming President that the current models of paying for health care, which reward volume of care over value or quality, may hinder promising new avenues that would avoid expensive late-stage treatments or prevent disease.

The Health Secretary’s comments, which appear in the second report of the Initiative on Personalised Health Care which he set up in 2006, caution that putting an effective personalize health care system in place will be the work of a generation. We are now just at an early stage in our ability to differentiate between variations in the biology of individual patients and provide effective treatment for different diseases, he says.

“We have developed powerful pharmaceuticals, yet most drugs prescribed in the United States today are effective in fewer than 60% of treated patients; this efficacy rate reflects the variability of metabolism or other factors from person to person,” he writes. For example, one study has found that prescribed drugs are ineffective or less effective for at least 70% of patients taking angiotensin-converting enzyme (ACE) inhibitors and beta-blockers, for nearly 40% of people prescribed antidepressants and for at least 30% among those prescribed stations for high blood pressure or given beta 2 agonists for asthma.

“It remains common medical practice to follow a trial-and-error process for finding the right diagnosis, the right treatment and the right pharmaceutical dosage for each patient,” writes Sec Leavitt.

Nevertheless, he hopes that within 10 years it will be “the norm for consumers and practitioners to anticipate that treatments should be individually targeted, with diagnostics and therapies commonly associated as a paired unit.”

Moreover, within 15 years, he hopes that “major clinical data sources can be securely linked in a manner that gives most Americans the option of allowing their own de-identified health information to be employed in the quest for ever-more individualized understanding of health and disease. And within 20 years: “I hope that data and information will have advanced to the point of supporting meaningful individual prediction regarding and individual’s life-long health prospects, including specific, proven steps that he or she can take to protect and enhance health,” he writes.

- In 2007, Senator Obama introduced the Genomics and Personalized Medicine Act (S 976) into the Senate. A new version (HR 6498), with some changes, was introduced in the House of Representatives in September by Patrick Kennedy, the Democratic Representative for Rhode Island.