Conceptual and terminological confusion around personalised medicine: a coping strategy

Abstract

BackgroundThe idea of personalised medicine (PM) has gathered momentum recently, attracting funding and generating hopes as well as scepticism. As PM gives rise to differing interpretations, there have been several attempts to clarify the concept. In an influential paper published in this journal, Schleidgen and colleagues have proposed a precise and narrow definition of PM on the basis of a systematic literature review. Given that their conclusion is at odds with those of other recent attempts to understand PM, we consider whether their systematic review gives them an edge over competing interpretations.DiscussionWe have found some methodological weaknesses and questionable assumptions in Schleidgen and colleagues’ attempt to provide a more specific definition of PM. Our perplexities concern the lack of criteria for assessing the epistemic strength of the definitions that they consider, as well as the logical principles used to extract a more precise definition, the narrowness of the pool from which they have drawn their empirical data, and finally their overlooking the fact that definitions depend on the context of use. We are also worried that their ethical assumption that only patients’ interests are legitimate is too simplistic and drives all other stakeholders’ interests—including those that are justifiable—underground, thus compromising any hope of a transparent and fair negotiation among a plurality of actors and interests.ConclusionAs an alternative to the shortcomings of attempting a semantic disciplining of the concept we propose a pragmatic approach. Rather than considering PM to be a scientific concept in need of precise demarcation, we look at it as an open and negotiable concept used in a variety of contexts including at the level of orienting research goals and policy objectives. We believe that since PM is still more an ideal than an achieved reality, a plurality of visions is to be expected and we need to pay attention to the people, reasons and interests behind these alternative conceptions. In other words, the logic and politics of PM cannot be disentangled and disagreements need to be tackled addressing the normative and strategic conflicts behind them.

I’ve Gut A Feeling: Microbiota Impacting the Conceptual and Experimental Perspectives of Personalized Medicine

“…Indeed, these expressions are often used interchangeably [48]. This semantic blurriness [49] mirrors economic, institutional solutions and approaches, aiming at the establishment of a new paradigm for health care systems.…”

Médecine de précision et Evidence-Based Medicine : quelle articulation ?

“…Or des auteurs (Dion-Labrie et al 2008 ; de Leon 2012) ont déjà montré qu'opposer la MP et l'EBM n'a pas vraiment de sens : elles partagent le même objectif de rendre la clinique plus efficace. À partir d'une analyse centrée sur la cancérologie, nous voulons montrer que la médecine de précision conduit avant tout à rééquilibrer la part du raisonnement mécanistique dans l'EBM et lui impose de nouveaux défis pour l'évaluation des niveaux de preuve et l'intégration de différents types de preuve.…”

Medicina di Precisione e Medicina di Laboratorio

“…Di fatto, però, in letteratura la maggior parte degli autori utilizza i termini in modo intercambiabile, anche se un dibattito approfondito, come quello sul termine "Personalised Medicine", sarebbe necessario [16].…”