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In Reply: Mr Anesi highlights an important aspect of the potential of individualized medicine. For current chemotherapeutic agents, the combination of high risk of adverse events, high cost, and documented variability in efficacy makes them a prime area for the application of genetically guided therapy. Successful application of genetic technology in this arena may provide improved outcomes as well as the potential for reduced cost. However, as pointed out in my Commentary, there are serious challenges in ensuring broad access among patients to this emerging technology and its benefits. Given how common malignant disease is, a large part of the population stands to benefit from more-precisely directed therapy. Thus, broadly sharing responsibility for ensuring universal access to the fruits of this burgeoning technology is both logical and just.

Financial Disclosures: None reported.

James P. Evans, MD, PhD
jpevans@med.unc.edu
Department of Genetics
University of North Carolina
Chapel Hill

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2008;299(13):1544.

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