Giving a bump to this essay from 2011 for my students in “Individuality in medicine from antiquity to the genome age.” Also took the opportunity to edit it lightly and fix a couple of formatting/coding glitches. (Sorry about the apparent broken image at the top–it doesn’t show up in the editor, so I can’t figure out how to fix it. Any broken sentences, however, are my own fault.)
4 thoughts on “Putting the person into personalized medicine (redux)”
I really enjoyed reading this eloquent rundown of the history of “personalized medicine.” I’m curious – is being put into several smaller boxes always better than being put into one big box? Is more personalized always better than not personalized at all? I agree that consumers of healthcare ought to understand that “personalization” has its limitations technologically and physiologically as well as socially. Tailoring biochemical compounds to individuals can only go so far, and even then you are using race, age, weight, pre-existing conditions, and sex to categorize individuals into acceptable dosage tiers. And this is only considering the ‘objective’ side of the double-edged sword of personalized medicine rather than its potential social ramifications: race vs. racism, sex vs. sexism, age vs. ageism, etc. Regarding the categorization of biomedical knowledge, one step too far and you’re in the murky waters of drawing harmful social boundaries rather than constructive ‘scientific’ ones.
I wonder, though, do you think it is possible that we’re acquiring too many boxes? Do you think the over-complication of assigning multiple medical identities, which are invariably intertwined with social ones, can at times provide us with a false sense of security in the personalized medical diagnostic/prognostic process? I suppose I agree that more personalized is typically better if it’s true. But it’s not always true, and “true” is generally a very fuzzy concept in biostatistics (e.g. it’s true that if you have X gene, are over 150 pounds, and older than 50 years old you are 5x more likely to acquire Y type of cancer, supported clearly by the fact that p<.05). That certainly seems more personalized, but does it lead to a more productive diagnosis? I’m not so sure. I don’t mean to criticize clinical studies, only to point out that this is another way in which our confidence in personalized medicine sometimes exceeds its present competence. The idea of more boxes and more identities is a great one, but I'm not totally convinced they all actually exist.
Thanks for your comment. No, of course sometimes “one size fits all” is appropriate medical care–when variation is minor, rare, and insignificant to the therapy, one big box is just fine. I think the personalized approach is a nice ideal. It’s humane and it helps counteract dangerous typological thinking. But it’s an ideal, and ideals often get hyped. One of the major points of my book is that on a broad scale, the best medical care results from a flexible balance of individualized and population thinking. And I think we need to reassess in just about every case what that balance should look like. Sounds like that’s just what you’re doing.
Ah yes, the persistent Garrodian-Galtonian tug of war. I hope I didn’t imply that your argument for striking this balance was not well conveyed; I was merely thinking out loud about details. I actually recently finished reading your book, and it was awesome (for lack of time, space, and a more eloquent adjective). And thanks for entertaining my box analogy, as well as my underdeveloped train of thought.
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