What is the Future of Diagnostic Medicine?

by John B. Carnett John B. Carnett

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What's left of the General Tso's chicken is on the coffee table. The sauce that eluded my mouth is congealing on my T-shirt. American Idol just started. And Megan, my fiance of three days, is getting ready to swab the inside of my mouth with Q-Tips that are nearly as long as chopsticks. "OK, open that mouth," she says. "Wider." She is a doctor. I do as I'm told. "You know, these look like little Pap-smear brushes," she muses. My mouth snaps closed. "C'mon, open up," she says. I stall. "I love you," I say. "Kiss me." "Let me concentrate," she says. "What if I don't do this right?" "Then," I reply, "I guess I'll never know if I'm gonna die." Megan, at my behest, is after my DNA, because I am after the future of my body. This was my assignment: to take every medical test I could get my hands on to predict what will happen to my body 5, 10, 15 years from now. I set out to find the most advanced diagnostics available, early examples of technologies that would get me as close as possible to the future of medicine, when doctors will use genetic and imaging tests to predict what diseases a person is prone to developing. When illness does strike, treatments will be tailored to each patient. The researchers, doctors and drug companies working on this new gene-based paradigm are calling it personalized medicine. Their buzzphrase: "The right treatment for the right person at the right time."

In many ways, my editor handed me my dream job. I have nursed a rather robust interest in my robust body for some time, starting when I asked my parents, at the age of 12, to take me to the doctor because I felt a lump under my left nipple. They indulged me-and they did so again a few years later when, during a tour of colleges, I was so certain that I was dying from a urinary tract infection that I made them rush me to a hospital in Columbia, Missouri. The diagnoses: normal nipple, normal urine. Before I met Megan, I had no idea doctors called people like me "the worried well." This was good news; I had assumed I was just a hypochondriac.

Sitting here on our couch, though, my fiance and I have to acknowledge the peculiar irony that something could, in fact, be wrong with me, that I might be harboring genes that will send me into the ground sooner than planned. That this might be bigger than my nipple.

"If it turns out that you're going to get some crazy disease, you can sell the engagement ring and use the money for your treatment," Megan tells me, only half joking. She tilts my head so she can grind the swabs deeper into my cheeks.

Sounding like people do when they have a dentist's fingers in their mouths, I ask, "Are you doing this right?"

"I am not an idiot," Megan says, sounding just like herself.
I slip each swab into a padded envelope with extra-sticky sealing, so as not to leak bodily fluid on the FedEx man. In a couple weeks I hope to have a good idea of what will kill me, and when. I smile at Megan. And she says, "I should have waited for the results before I agreed to marry you."