Personalized medicine: ‘Tyranny of the gene’ (original) (raw)
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Clinical Ethics, 2014
The sequencing of the human genome and decreasing costs of sequencing technology have led to the notion of ‘personalized medicine’. This has been taken by some authors to indicate that personalized medicine will provide individualized treatments solely based on one’s DNA sequence. We argue this is overly optimistic and misconstrues the notion of personalization. Such interpretations fail to account for economic, policy and structural constraints on the delivery of healthcare. Furthermore, notions of individualization based on genomic data potentially take us down the road of genetic reductionism obscuring the role of environmental factors in disease and ill health. We propose that one should see personalized medicine as a way of using personal genomic information to stratify individuals into subpopulations and suggest that personalized medicine be seen within a broader idea of personalized healthcare, reflecting healthcare that integrates personal genomic data into cultural, environmental and personal contexts.
Personalized Genomic Medicine and the Rhetoric of Empowerment
Hastings Center Report, 2012
Advocates of "personalized" genomic medicine maintain that it is revolutionary not just in what it can reveal to us, but in how it will enable us to take control of our health. But we should not assume that patient empowerment always yields positive outcomes. To assess the social impact of personalized medicine, we must anticipate how the virtue might go awry in practice. Human genome research owes a debt of gratitude to the historian of science Thomas Kuhn, who introduced the idea that conceptual change in science can happen through "paradigm shifts" that go beyond incremental problem-solving. 1 While Kuhn was agnostic about whether such revolutions necessarily constitute "progress," the popular understanding has become that paradigm shifts are the most effective form of scientific progress. As a result, appealing to the prospect of a "paradigm shift" for biomedical science has been successful in generating public and private investment in genomics research, and a wide variety of stakeholders promote its translational goals as a new paradigm for medicine, under the banner of "personalized genomic medicine." 2 As Francis Collins, long-time leader of human genomics research in the United States, puts it: We are on the leading edge of a true revolution in medicine, one that promises to transform the traditional "one size fits all" approach into a much more powerful strategy that considers each individual as unique and as having special characteristics that should guide an approach to staying healthy. … If you are interested in living life to the fullest, it is time to harness your double helix for health and learn what this paradigm shift is all about.
Will Genomics Widen or Help Heal the Schism Between Medicine and Public Health?
American Journal of Preventive Medicine, 2007
We discuss the "schism" between medicine and public health in light of advances in genomics and the expected evolution of health care toward personalized treatment and prevention. Undoubtedly, genomics could deepen the divide between the two worlds, but it also represents an important and perhaps unique opportunity for healing the schism, given the volume of new scientific discoveries and their potential applications in all areas of health and disease. We argue that the integration of genomics into health care and disease prevention requires a strong medicine-public health partnership in the context of a population approach to a translational research agenda that includes four overlapping areas: (1) a joint focus on prevention-a traditional public health concern but now a promise of genomics in the realm of individualized primary prevention and early detection, (2) a population perspective, which requires a large amount of population-level data to validate gene discoveries for clinical applications, (3) commitment to evidencebased knowledge integration with thousands of potential genomic applications in practice, and (4) emphasis on health services research to evaluate outcomes, costs, and benefits in the real world. A strong medicine-public health partnership in the genomics era is needed for the translation of all scientific discoveries for the benefit of population health. (Am J Prev Med 2007;33(4):310 -317)
After the revolution? Ethical and social challenges in ‘personalized genomic medicine’
Personalized Medicine, 2012
Personalized genomic medicine (PGM) is a goal that currently unites a wide array of biomedical initiatives, and is promoted as a ‘new paradigm for healthcare’ by its champions. Its promissory virtues include individualized diagnosis and risk prediction, more effective prevention and health promotion, and patient empowerment. Beyond overcoming scientific and technological hurdles to realizing PGM, proponents may interpret and rank these promises differently, which carries ethical and social implications for the realization of PGM as an approach to healthcare. We examine competing visions of PGM’s virtues and the directions in which they could take the field, in order to anticipate policy choices that may lie ahead for researchers, healthcare providers and the public.
Personalized medicine (PM) is one of the promising technologies in medicine aimed at developing targeted diagnostics and therapies in “the war on cancer” and other life-threatening diseases. Personalized or precision medicine has been generally justified by finding the right treatments, at the right dose, at the right time for the right person, every time, and simultaneously, increasing the efficiency of health care systems by predicting and treating individual predispositions to diseases or conditions. PM promises to be at the forefront of governmental and scientific agendas for the foreseeable future. It is likely that pharmaceutical companies will continue to work toward developing precision medicine treatments and diagnostics, not just in Europe but worldwide. Addressing cross-cutting concerns, this conference aims at a better understanding of PM by explaining the various dimensions of the move towards personalized medicine.
Emerging genomic technologies and the concept of personalized medicine
Cell Cycle, 2008
With the completion of the Human Genome Project in May 2006, genetic testing for every American is rapidly becoming a reality. As the advanced technology fuels the path towards personalized medicine, genetic nondiscrimination legislation follows closely behind. It seems that the 2007 Genetic Information Nondiscrimination Act (GINA) will finally pass through both chambers of Congress and will be signed by the President, but questions remain. On May 1, 2008, the House passed GINA by a vote of 414 to 1. Why is this the year that genetic nondiscrimination legislation could finally become the reality? Is this the beginning of a new relationship between science and policy, where policy is finally catching up? We examine the answers to these questions through a look at the history of genetic nondiscrimination legislation and where it stands today, including arguments for and against the bill. We conclude by discussing how we can achieve a future of safe personalized medicine for the populous, which would require continuous productive interactions between policymakers and scientists.
Personalized medicine and preventive health care: juxtaposing health policy and clinical practice
Critical Public Health, 2019
Health care systems around the globe are currently orienting themselves towards 'personalized medicine', a medical care regime aimed at individualizing prevention, diagnosis, and treatment of disease through proliferating amounts and sources of data, including genetic information. In Denmark, national health policies on personalized medicine focus on harnessing the potentials of genomic science and technology to bring knowledge about patient-specific genetic variation into clinical application. A major hope is to improve public health and prevent common diseases by integrating genomic information in health care, yet to act preventively, a temporal path has to be established defining what kind of knowledge to create and to act upon, and when. This paper explores the temporal orderings of medical knowledge in two different areas: health policy and clinical practice. Examining policy papers on personalized medicine issued by Danish governmental and research institutions, and, comparing them with contemporary practices of using genetic information in preventive cardiac health care, we demonstrate that genetic knowledge-making is ordered around two different conceptual views of time: namely the sequential order and the speed with which such knowledge is produced. We argue that the visions of knowledge-making and early intervention through genomic science and technology as conveyed in policy papers on personalized medicine, challenge preexisting practices and understandings of what constitutes timely prevention and actionable knowledge within clinical care. We close the article discussing how prevention through genomics amplifies the significance of the clinical space for public health as a site for sense-making and translation of controversial genetic knowledge.
Personalized Medicine and Cancer
Journal of Personalized Medicine, 2012
Cancer is one of the leading causes of death in the United States, and more than 1.5 million new cases and more than 0.5 million deaths were reported during 2010 in the United States alone. Following completion of the sequencing of the human genome, substantial progress has been made in characterizing the human epigenome, proteome, and metabolome; a better understanding of pharmacogenomics has been developed, and the potential for customizing health care for the individual has grown tremendously. Recently, personalized medicine has mainly involved the systematic use of genetic or other information about an individual patient to select or optimize that patient's preventative and therapeutic care. Molecular profiling in healthy and cancer patient samples may allow for a greater degree of personalized medicine than is currently available. Information about a patient's proteinaceous, genetic, and metabolic profile could be used to tailor medical care to that individual's needs. A key attribute of this medical model is the development of companion diagnostics, whereby molecular assays that measure levels of proteins, genes, or specific mutations are used to provide a specific therapy for an individual's condition by stratifying disease status, selecting the proper medication, and tailoring dosages to that patient's specific needs. Additionally, such methods can be used to assess a patient's risk factors for a number of conditions and to tailor individual preventative treatments. Recent advances, challenges, and future perspectives of personalized medicine in cancer are discussed. OPEN ACCESS J. Pers. Med. 2012, 2 2