Internal Medicine & Gene Therapy

Gene therapy is usually organised around an indication, which leaves the patient divided between specialists who each own a part. This division owns the whole: the evaluation that determines whether an intervention is appropriate at all, the comorbidities and medications that determine whether it is safe, and the longitudinal follow-up that continues after the treating specialist has finished.

Candidacy is the substance of the work, and declining is a routine outcome of it. Pre-existing neutralising antibodies exclude a patient from a given vector. Hepatic or cardiac findings make a dose unsafe. An untreated condition takes priority over an elective intervention. A realistic expectation cannot be established. Each is a common and correct reason not to proceed, and a service that never reaches that conclusion is not evaluating anyone. Regulatory guidance for gene therapy contemplates follow-up measured in years rather than weeks, and this division is what makes that follow-up real rather than nominal.