Page 38 - Binder2

Too Normalized in Clinical Practice

Tolerization has become so common that it’s normalized.
In rheumatology, gastroenterology, oncology, and rare
disease clinics, patients failing one biologic and moving to
another is treated not as a red flag, but as standard care.

There are even algorithms for it:

• Fail Drug A? Move to Drug B.
• Fail Drug B? Add methotrexate.
• Fail both? Consider a third-line option.

What these flowcharts don’t say—but what every specialist
knows—is that each step often carries lower odds of
success than the last. Every switch compounds immune
complexity. Every add-on introduces new risk. Yet the
underlying issue—the body’s mounting immunologic
rejection of biologics—goes largely unaddressed.

This normalization masks the severity of the problem.
What should be seen as immunological rejection of a
high-cost therapy is instead treated as an expected part of
the patient journey. It trains clinicians to manage around
the dysfunction, not interrogate it. It makes failure feel
procedural instead of preventable.

Clinicians are managing around the problem—not solving
it.

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