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The Promise And Limitations Of Smart Drugs

As a scientist, I still remember the excitement after hearing the presentation of Dr. Francis Collins (director of the Human Genome Project) and can't wait to see how genetics and personalized medicines mature and benefit mankind ("Drugs get smart," Cover Story, Sept. 5). But this only improves the ratio of benefit (screen who may have the genetic profile to respond to a drug) to risk (identify the subpopulation with different metabolizing powers). It will not remove the intrinsic risk associated with medicines.

As pharmacologically active compounds, medicines will have some intrinsic toxicities. Some molecules will probably have off-target activities (i.e., they will hit receptors other than the intended target). Some molecules will hit the biological pathways that are associated not only with disease but also with other, normal biological functions. How we strike the balance among risk, benefit, and cost will define the health-care system.

Albert Ren

North Wales, Pa.

In your otherwise well done story, you wrote that Roche's AmpliChip CYP450 "is the first genetic test approved by the Food & Drug Administration to identify responses to a wide variety of medications." This is technically true, but tests for the gene variants targeted by the AmpliChip have been available at many clinical labs for years without specific FDA approval. That's because approval is not needed for tests developed and performed by qualified labs as long as they aren't marketed commercially as packaged kits or devices.

Also, Roche initially tried to market the AmpliChip in July, 2003, without FDA approval. The agency immediately sent the company a warning letter, and Roche spent months trying in vain to persuade the FDA that the AmpliChip was not a device needing pre-market review. This foolishness kept AmpliChips off the U.S. market for more than a year.

John Gever

Morgantown, W. Va.

Editor's note: The writer is editor of the newsletter Diagnostics Intelligence.

As economic adviser to a leading Swiss pharmaceutical company for 33 years, I read "Drugs get smart" (Cover Story, Sept. 5/12) and found only one sentence that is fully in line with my experience: "More than 100,000 people die from drug side effects each year [in the U.S. alone]." Health care's weapons of mass destruction: the Standard American Diet (SAD) -- with so many Americans overweight -- and our so-called high-tech drugs, which merely suppress symptoms and never deal with causes.

Moli?re, in his play Le Malade Imaginaire ("The Hypocondriac"), said more than 300 years ago: "If we leave nature alone, she recovers gently from disorder into which she has fallen. It is our anxiety, our impatience, which spoils all; and nearly all men die of their remedies, not of their diseases." In drawing readers' attention to this important human wisdom, you might not only save their lives but also conserve them as your subscribers.

Otto H. Nowotny

Basel, Switzerland

Re "Sharks in the housing pool" (News: Analysis & Commentary, Sept. 5): Across the country, corporate owners of manufactured-home parks are perpetrating a mortgage swindle that victimizes both banks and local communities. Manufactured homes are sold to unsuspecting owners who also must rent the land the home sits on. When the homeowner wants to sell, all the park owner needs to do is raise the land rent so outrageously that no new owners appear. Unable to sell, the owner or his or her heirs are forced to surrender the home to the bank. The park owner can then retake the home and sell it again to new victims.

Linda Ponzini

Watsonville, Calif.

Despite being heralded as one of the world's most innovative companies, every "innovation" that Google Inc. (GOOG) seems to have planned is either an acquisition or a replication of an existing idea ("Google's grand ambitions," News: Analysis & Commentary, Sept. 5). The company's true strength is in its brand -- and really only in search. Google needs to remember that, or else all of these brand extensions won't mean anything. Unfortunately, there already seems to be a growing revolt among some of tech's savviest, as Google's search-engine-results pages (SERPs) fall behind those of MSN's (MSFT) and even Yahoo!'s (YHOO).

AdWords and AdSense are both great programs, but enrollment is high only because Google is the Wal-Mart (WMT) of search (both attract big audiences, which allow them to take an "our-way-or-no-way" stance). If Google's search falls behind any further, the door will be open for new search technologies to claim the throne -- and the accompanying ad revenue.

J.D. Amer

Akron, Ohio

I can't believe BusinessWeek swallowed the junk they served you at Kraft Foods Inc. (KFT) ("Slimmer kids, fatter profits?" People, Sept. 5). Its supposedly healthy "pizza de resistance" has 36 grams of sugar. For comparison, a "fun-size" Butterfinger bar has 10 grams of sugar. In other words, Kraft's "healthy" meal has about four times as much sugar as a serving of candy. They don't need to worry about the dessert they include in their Lunchables Lunch Combinations: The whole thing is dessert!

C. Andrew Aligne, M.D.

University of Rochester

Rochester, N.Y.

Editor's note: The writer is a pediatrician, public-health researcher, and children's health advocate.

It's all well and good for Kraft to improve the nutritional value of its meals, but what is the overall benefit ? A 200% increase in fiber is probably a good thing, but what was the starting point? What is the overall nutritional value of these "foods" following the improvements? As for Kraft slimming down the Oreo, it tastes good the way it is. How about eating one or two cookies at a time, not an entire bag?

Pamela R. Chang


In "Can the Democrats seize the day?" (Washington Outlook, Aug. 22/29), Richard S. Dunham says "voters have had it with President Bush's handling of the economy." Then, in "Sticking to the sweet spot" (Corporate Scoreboard, Aug. 22/29), BusinessWeek reports that "profits have risen for 10 straight quarters" and "thanks to a robust economy...profits for the 900 companies on BusinessWeek's Corporate Scoreboard rose by...20% in the second quarter." This is accompanied by a photo of shoppers lined up, captioned "Costco (COST) has cashed in on consumers' eagerness to shop." It seems to me that consumers are enjoying the Bush tax cuts and are busy fueling our economy.

Jim Wallwork

Chevy Chase, Md.

I read "China & India: What you need to know now" (Cover Story, Aug. 22/29) after returning from my first business trip to India -- to Hyderabad to visit with the team at our Indian affiliate. I was struck by the progressive, can-do attitude of not only Indian workers but of management at all levels, business leaders, and government ministers. Also, individual Indian states are vying hard to attract U.S. and foreign business, providing a competitive environment for U.S. business.

For example, the current Hyderabad airport would rate as a second-tier regional airport in the U.S., and the local road infrastructure is severely stressed, but the government is planning a new international airport, with new roadways, that will increase Hyderabad's competitiveness in securing additional outsourcing work.

I was also impressed by the growing support of business in improving overall education programs for children. For example, employees of our company's Indian affiliate, iSpace, donate to a local public school, helping to upgrade the level of education provided. And there is a general recognition that by ensuring that literacy and math skills are widely taught, India will always have a workforce that can be competitive with any other country and win increasing business from the developed nations.

Andrew Masetti

CFO, Amisys Synertech Inc.

Rockville, Md.

As a Chinese student studying in the U.S., I found that BusinessWeek's special report answers a question that has haunted me for a long time: What are the differences between China and India in terms of economic development? India's long colonial history and Western-style political, economic, and education system make it easier for the country to enter the international info-tech and financial-services markets. China, except for technology and management knowhow, never fully accepted or welcomed Western culture and values. Most Chinese students in the U.S., because of language and cultural barriers, have difficulty entering U.S. society.

After 15 or 20 years, India, with its growing U.S. and European ties, probably will be the largest service supplier behind most of the world's top companies. China, with knowledge brought back by foreign-educated Chinese students, will become a more independent figure in the global market.

Jingjing Zhang


Is it possible that a historian in 2100 looking at the slide of the U.S. into second-tier-nation status will put your "Evangelical America" (Special Report, May 23) and your "China & India" next to each other and recognize what happened?

During both World War II and the Cold War, the U.S. had a reasonable balance between science and faith. In recent years, witness the collapse of proper funding for particle physics, the failure to have a legitimate replacement for the Hubble telescope, a space program likely to lose its way trying to send humans to Mars, a government that fears and underfunds microbiology, the start of a reverse brain drain of world-class scientists to Europe and Asia, and the emerging wreckage of science education in high schools -- with folks eager to wreck it at the university level, too.

If the looming science gap isn't a clear and present danger to the well-being of the country, what is?

Neil Lichtman

Naperville, Ill.

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