The Pleiotropic Art of Medicine

Greg A. Hood, MD

Disclosures

July 06, 2015

In This Article

The Pleiotropic Effects of a Drug

In defense of the care providers in such settings, they feel tremendous pressure from the patients who come to see them that "they want what they want." They feel this pressure because their employers do nothing to deflect it. In fact, the perception of those to whom I have spoken is that such pressures are amplified by those who sign their paychecks. Out of a perceived eagerness for profit, the complexity of human health and illness is compressed into fragmented encounters and simplistic algorithms in non-Watson medical decision-support systems. When the ethics of such processes aren't given complete consideration, the unintended consequences can be substantial. (For more on this topic, see the Medscape article "Recommendations for the Ethical Development and Use of Medical Decision-Support Systems.")

What seems to be in jeopardy is an understanding of the pleiotropy of the human body and, as an extension, medical decision-making for care of the human body. "Pleiotropy" refers to multiple effects coming from a single gene, or a specific treatment. Common examples are, according to MedicineNet.com, the Marfan gene as "pleiotropic, potentially causing such diverse effects as long fingers and toes (arachnodactyly), dislocation of the lens of the eye, and dissecting aneurysm of the aorta," and 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG-CoA) reductase inhibitors.

Pleiotropic effects of a drug are actions other than those for which the agent was specifically developed. These effects may be related or unrelated to the primary mechanism of action of the drug, and they're usually unanticipated. Pleiotropic effects may be undesirable (such as side effects or toxicity); neutral; or, as is especially the case with HMG-CoA reductase inhibitors (statins), beneficial. Pleiotropic effects of statins include improvement of endothelial dysfunction, increased nitric oxide bioavailability, antioxidant properties, inhibition of inflammatory responses, and stabilization of atherosclerotic plaques. These and several other emergent properties could act in concert with the potent low-density lipoprotein cholesterol-lowering effects of statins to exert early, as well as lasting, cardiovascular protective effects.[3,4]

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