From art to science: a new epistemological status for medicine? On expectations regarding personalized medicine

Abstract

Personalized medicine plays an important role in the development of current medicine. Among the numerous statements regarding the future of personalized medicine, some can be found that accord medicine a new scientific status. Medicine will be transformed from an art to a science due to personalized medicine. This prognosis is supported by references to models of historical developments. The article examines what is meant by this prognosis, what consequences it entails, and how feasible it is. It refers to the long tradition of epistemological thinking in medicine and the use of historical models for the development of medicine. The possible answers to the question "art or science" are systematized with respect to the core question about the relationship between knowledge and action. The prediction for medicine to develop from an 'empirical healing art' to a 'rational, molecular science' is nonsensical from an epistemological point of view. The historical models employed to substantiate the development of personalized medicine are questionable.

A New Time of Reckoning, a Time for New Reckoning: Views on Health and Society, Tensions between Medicine and the Social Sciences, and the Process of Medicalization

“…A similar meaning was accommodated by the contemporary conceptualization of medicine itself as a social science. This understanding of medicine as an art, as a human science, as a social science, or the very conception of medicine from a humanist point of view has been mainly mobilized to respond to conceptions not only more scientific but above all, more technological of medicine, having a non-negligible role in the organization of hospital services and in the articulation of, or resistance to, new movements within institutionalized medicine, such as evidence-based medicine or personalized medicine [84][85][86][87]. In turn, it is not alien to this nexus the correspondence of the idea of social science itself, especially that of sociology, with a form of medicine, a very common correspondence in the American sociological literature of the 20th century [88].…”

Precision medicine and monoclonal antibodies: breach of promise?

“…Focused on biology rather than on other variables, such as lifestyle or environment, PM presents itself as the ultimate science, and its full promise goes even beyond targeting therapies for patients (14) and includes the ability to identify healthy individuals at high risk and take preventive measures for them (15). The PM’s basic assumption is that genetics is the underlying factor in most health conditions, so diseases are mainly affected by the human genetic make-up (16). Progress in characterizing individual differences in genomic sequences should extend the application range of PM from rare monogenic diseases to more common and genetically complex pathologies (17).…”

“…Politically exploited by the former president of the USA to successfully baptize a major research initiative (2), PM has aroused great expectations as a “weapon” that will defeat most human diseases in the next decades and fully transform medicine from art to science (16,18). However, clinical results so far have not been as encouraging as promised.…”

“…If no therapies are available, the value of diagnosis or risk stratification is very limited (5). Even more, combining various risk markers not necessarily implies providing clinically meaningful information, and much variability in therapeutic efficacy is not genetically driven (16). So, regardless of PM progress, complete success is still unlikely.…”

Precision in health care

“…Without the prospect of big returns in the future, state agencies, politicians and companies will no longer invest in this type of basic research. A more critical view is presented in the contribution of Wiesing (2018). He analyzes the claim that precision medicine will improve the epistemological status of medicine, thus promoting it from art to science.…”