Precision Medicine and the Challenges of Human Complexity

Abstract

It is difficult to pick up a medical journal in almost any specialty and fail to see an article about precision medicine or precision (fill in the blank) specialty. It seems to be taking over much of the medical discourse. The National Academy of Sciences (NAS) 2011 report Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease stated: "'Precision medicine' refers to the tailoring of medical treatment to the individual characteristics of each patient to classify individuals into subpopulations that differ in their susceptibility to a particular disease, in the biology and/or prognosis of those diseases they may develop, or in their response to a specific treatment" [1]. The promise of precision medicine is the development of very specific therapies "to target right treatments to the right patients at the right time, a silver bullet specific to each patient" [2, 3]. To achieve this promise, accuracy is required in identifying the correct target and hitting that target precisely. The assumption underlying precision medicine, as currently practiced, is that the targets are at the molecular level, especially DNA. This is most evident in precision medicine's approach to cancer, the near-term focus of the Precision Medicine Initiative.

Clinical Interviewing: An Essential but Neglected Method of Medicine

“…Despite its importance and efficacy, interviewing as a basic skill is threatened by a variety of forces that result in skill erosion, if not outright neglect. These forces include the allure of technology, time pressures, use of shortcuts such as questionnaires and chatbots, and the hegemony of the biomedical model of disease as exemplified by "precision medicine" [8][9][10][11]. Further, the level of details that are required in many health care systems to provide written documentation of the interview can burden the clinician and negatively affect the nature of the interaction with the patient.…”