How can urologists separate personalized medicine from marketing?

Separating legitimate personalized medicine from personalized marketing depended on clinicians staying current with the evidence and distinguishing therapies supported by robust clinical trials from those supported by anecdote, according to Jean Cunningham, PharmD, BCPS, senior director of Medical Affairs for Empower Pharmacy. Professional organizations, including the American Urological Association, had produced content that stayed close to the evidence and served as a useful resource for clinicians.¹

Patients often cited improvements reported by friends or noticed on their own, and those experiences had to be incorporated into the clinical conversation. Many patients in this space were receptive to discussions of study design, according to Cunningham.

“Study design helps explain to patients, ‘hey, you might have noticed a benefit, but what were you comparing it to?’ ” she said.

Study design also mattered when layering therapies. Testosterone replacement therapy was a reasonable starting point, but additional therapies should be introduced gradually rather than all at once, so clinicians could assess how the patient responded, how levels changed, and how the patient felt.

Personalized marketing was impactful because it promised patients they would feel much better by doing everything at once. Clinicians could counter that by setting expectations, pointing to the evidence, describing the expected response, and explaining that benefit would likely take longer than marketing suggested. Medication alone was insufficient; a holistic approach that addressed sleep, diet, nutrition, exercise, and stress was essential. These were familiar fundamentals, Cunningham said, but flashy marketing led some patients to skip them in favor of a single treatment expected to solve everything.

Interest in nicotinamide adenine dinucleotide (NAD+) and related products was understandable given a plausible mechanism, as NAD+ was involved in cellular energy metabolism. However, the evidence stopped at mechanism, Cunningham said.

“We see a lot of patients who feel better, but clinical evidence has not caught up with many of those anti-aging claims,” she said.

Early studies of NAD+ precursors, including nicotinamide riboside and nicotinamide mononucleotide, suggested they may raise NAD+ levels and affect certain biomarkers, but data on clinically meaningful end points were lacking.² Claims regarding longevity, strength, cognition, and energy were not supported by strong evidence.

Many patients nonetheless were unwilling to wait for the evidence, and some would be ready to try NAD+ anyway. Dismissing NAD+ outright risked creating a barrier between clinician and patient, Cunningham noted. Remaining aware of where the emerging evidence stood was helpful. A more productive approach acknowledged that NAD+ was interesting while recommending therapies with stronger evidence first. For patients determined to try NAD+, clinicians could remain informed, specify what they would monitor, and work with patients through the process, which Cunningham described as a valuable aspect of the clinician-patient relationship.

References

1. Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200(2):423-432. https://pubmed.ncbi.nlm.nih.gov/29601923/
2. Yaku K, Nakagawa T. NAD+ precursors in human health and disease: current status and future prospects. Antioxid Redox Signal. 2023;39(16-18):1133-1149. https://pubmed.ncbi.nlm.nih.gov/37335049/