Thursday, January 25, 2018

Precision Medicine and the Reinvention of Human Disease (The Myth)

If you believe the hype, we are entering a new era of medicine in which each individual will receive unique treatment, determined by the sequence of his or her genome. This widely promulgated notion is simply ridiculous. There is no practical way to develop a unique treatment, test the treatment for safety and effectiveness, and titrate the correct dose, all for one person.

The terms "Precision Medicine" and "Personalized Medicine" have given us the false impression that medical science is moving away from off-the-rack remedies and is seeking treatments tailored to the individual. In actuality, science has always been about seeking generalization. When Isaac Newton watched an apple drop, he was not working on a new Law of Falling Apples. He was trying to understand the general laws of gravity and motion that applied to every object in the universe. When Charles Darwin spent 8 years studying barnacles, he was not trying to build a display collection of handsome barnacles for the national museum. He was developing a general theory of evolution that would apply to every living organism on earth. Likewise, when we study a specific pathway that is operative in a small percentage of cases of a rare tumor, accounting for perhaps a dozen patients worldwide, we expect that our findings will have general application to a wide variety of conditions.

Precision Medicine has very little to do with developing unique treatments. Like all medical research, Precision Medicine seeks to find general treatments that will be effective for the largest number of patients. The "Precision" in Precision Medicine refers to our ability to precisely diagnose rare diseases, and subsets of common diseases, that share a particular sensitivity to particular forms of treatment.

- Jules Berman

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