Between hype and hope: What is really at stake with personalized medicine?

Abstract

Over the last decade, personalized medicine has become a buzz word, which covers a broad spectrum of meanings and generates many different opinions. The purpose of this article is to achieve a better understanding of the reasons why personalized medicine gives rise to such conflicting opinions. We show that a major issue of personalized medicine is the gap existing between its claims and its reality. We then present and analyze different possible reasons for this gap. We propose an hypothesis inspired by the Windelband's distinction between nomothetic and idiographic methodology. We argue that the fuzzy situation of personalized medicine results from a mix between idiographic claims and nomothetic methodological procedures. Hence we suggest that the current quandary about personalized medicine cannot be solved without getting involved in a discussion about the complex epistemological and methodological status of medicine. To conclude, we show that the Gadamer's view of medicine as a dialogical process can be fruitfully used and reveals that personalization is not a theoretical task, but a practical one, which takes place within the clinical encounter.

Contested futures: envisioning “Personalized,” “Stratified,” and “Precision” medicine

“…That some (including the European Commission) have conflated personalized and patient-centered medicine demonstrates, for Schleidgen and colleagues, that stakeholders can misuse the conceptual ambiguity of the term by inflating it with optimistic meanings according to their own agendas when, in reality , “tailoring means no more than stratification” (10). Several biomedical commentators have agreed: Abettan (2016, 426), for example, argues that “personalized” medicine “is catchy but misleading” for similar reasons, while Honoré (2012, 497) has remarked that given “all the complex processes that drugs undergo in the body, determining the pharmacokinetics and pharmacodynamics in detail will never be possible” and related new methods can thus only be described as stratified, not personalized dosing.…”

Precision medicine in an imprecise and complex world: Magic bullets, hype, and the fuzzy line between health and disease

“…Scientists also hype their own discoveries for the attention and in the hope of increasing the likelihood of future funding . Perhaps, the chief responsibility lies in our own seemingly limitless expectations especially for technological fixes . However, our expectations are often left unfulfilled as the new technology follows a somewhat predictable hype cycle through stages from a trigger phase with initial curiosity, then a peak with widespread publicity and inflated expectations, followed by a phase of disillusionment, a phase of enlightenment where the real use of the technology becomes clear, and a final plateau phase where the technology settles into the mainstream at a lowered level of hype …”

Happiness and its molecular fingerprints

“…However, the existing unmet needs and health inequalities may widen further with personalized medicine because of its high costs, with obvious repercussions at an individual and population level on perceived happiness (Abettan 2016). Personalized health builds on the unprecedented advances in high-through-put processing of big data as it becomes available from technological advances in eHealth, imaging, and molecular-omics analysis.…”