Stepping Beyond Personalized Medicine

One of the big consequences of the germ theory and the move towards a more scientific medicine was the consequent move away from the way medicine had been practiced. That sounds obvious, but here's what I mean: Scientific medicine (which is pretty much how we're all treated now) was the systematic and systemic use of rigor and experiment in medicine, so that some universal facts could emerge and patients could be treated for widespread, rather than individual, conditions. Meaning disease could be treated broadly, for many people at once, rather than piecemeal, each person to their own symptoms. This was distilled into the aphorism: Treat the disease, not the patient. The old way of treatment was called - and I love this term - idiosyncrasy (note the wikipedia link!), and it held that every patient's illness was idiosyncratic, and thus must be treated distinctly. Needless to say, this was very inefficient. But with a greater understanding of the broader causes of disease (especially infectious disease, via pathogens) and a greater opportunity to see disease before it manifests as symptoms (via X-rays or microscope), scientific medicine let the medical industry treat people in far greater numbers, with far better results. Which brings us the age of medicine and public health we have today.

Except: What's intriguing to me these days is how we're moving back to an age of idiosyncrasy.

This is, of course, usually called personalized medicine (Wikipedia link!), and its generally understood as the ability to use a patient's genome to understand and treat conditions they may have unto themselves, via pharmacology (pharmacogenomics is the term of art here). And as much as "personalized medicine" sounds like empty consumerist jargon, I think it will establish itself as a primary mode of care (more expert people than myself think so, too).

But here's what's really cool. No sooner will this idiosyncratic model remerge, than it will be superceded by a kind of collective idiosyncrasy: the use of large genome databases to extrapolate the notions behind personalized medicine onto a population scale. I'm thinking here of the HapMap project and many others.

I'm going to post more about these projects in coming days, but in the meantime - while I may have a few stray Slashdotters poking around - I'm eager to gather thread on the many diverse human genome databases and related consortia out there, I'm thinking of everything from the original National Human Genome Research Institute to things like the Cancer Biomarker Consortium at the Hutchinson Institute I mentioned the other day. If you have a favorite, drop it into the comments. I'll be reemerging with a bigger thought on them soon.

Thomas Goetz1 Comment