The Goldilocks Genome

The title refers to what happens when a drug meets a gene. Genes are the blueprints for the enzymes that metabolize drugs. Drugs are “just right” for about 40% of patients and “too much” or “too little” for the remainder. Outside of the Goldilocks zone, the results can be fatal.

Wendy’s suicide sets off a cascade of events leading to random deaths of an increasing number of people who are being treated with selective serotonin reuptake inhibitors (SSRIs).

The heroine is Carrie Hediger, the Director of the San Francisco district of the FDA, an epidemiologist whose best friend is one of the random victims. Convinced her friend has been poisoned, the heroine hones in on the murderer using statistics, persuasion, persistence, and disregard of the rules to trap him.

The novel reflects Elizabeth’s interests and skills. She has a doctorate in biomedical anthropology. She lived on Malo Island in Vanuatu for two years, where she developed her problem-solving epidemiology tools to investigate why some infants became chronic carriers of hepatitis B virus and not others.  After a brief stint in Academia, she went into New Product Development in the pharmaceutical industry, where she became Senior Vice President of Global Strategy for one of the top Swiss Pharma companies.

Twenty-five years ago, Elizabeth understood the promise of individual genotyping to tailor prescriptions. Popular fiction is a great way to educate people and push demand for better prescribing tools. The more people understand the benefits of personalized medicine versus today’s empirical “one size fits all”  prescribing algorithm, the faster it will be implemented, and the better will be the quality of our healthcare.