Wednesday, June 6, 2012

Patients are People, not Populations

This is my first blog post for my first blog, one that will be devoted to championing the personalized medicine approach to 21st century healthcare.  

What is "personalized medicine" (PM)? 
Definitions vary, but essentially, it refers to a “one size does not fit all” strategy of healthcare delivery.  This means, for example, that a drug that effectively treats asthmatics in the general population may not be right for me -- this has happened to me.  

Other ways to express PM include, “Right drug, right patient, right dose, right time” and P4 medicine (personalized, predictive, preventative, participatory).  Many scientists and physicians may also refer to this as "precision medicine," though perhaps more commonly genomic medicine.  
The key idea is this: treatment regimens can be custom-tailored to individuals by incorporating their unique genetic variation into their diagnosis, prognosis, and healthcare treatment.  

PM is not evidence-based medicine (EBM).  EBM developed as an honest attempt to improve clinical practice by focusing on scientific evidence (most often from clinical trials) rather than anecdotal data. Unfortunately, EMB while great in principle, became somewhat perverted in practice (see @murzee@TrishaTorrey, and Hickey and Roberts, 2011). I'll probably discuss this more  in future posts, but here will note that one major problem was using findings based on large populations of patients to treat individuals -- this has happened to me (bad outcomes).  

Healthcare and clinical practice has also become more personalized due to the internet, which has given rise to social media channels (e.g., blogs, Facebook, Twitter) that further communications among patients with similar diseases, allowing the sharing of symptoms, diagnoses, treatments, and so on. As a result, patients have become more empowered (e-Patients),  creating an unprecedented degree of personalization.  And doctors have noticed, and started treating such individuals as people, not populations.  

This blog, Personalized Medicine 101, is devoted to exploring PM most typically from the perspectives of genomic medicine as well as the internet (e.g. social media), both of which have had the biggest impact on personalizing medicine in recent history.  Since I may define PM more broadly than most, look to these pages to provide discussion about essentially anything related to improving personal healthcare in the 21st century. 

As people live longer and chronic disease conditions attract more attention, proper healthcare will continue to demand increased attention from all levels of culture and society. Here's to hoping I provide a positive contribution to that global conversation.  

Note: The Twitter hashtag #PM101 serves to locate all news and journal articles relevant to the medical elective I teach: PM101


  1. Robert, this is great. I am happy that you are focusing interest and information on PM. I just wrote an editorial for Critical Care Medicine (not sure when it will go to press) about personalizing how we present options on decision-making to parents of critically ill children. This kind of personalization is NOT based in genomics (well it might be) but still points out how wrong it is to generalize to ALL the fact that MOST (51%) want a certain approach.

    Congrats on the blog.

  2. Robert,

    Welcome to the blogosphere. I look forward to your posts as this is an area of great interest to me.

    I too started a blog not that long ago, and ironically use the "101" motif as well - mine is Cancer Research 101:

    You can see there that genomics, personalized medicine, precision medicine, the promise an caveats of genomic approaches to diagnose and treat cancer etc is a continuing theme over there. I invite you to check it out.

    Best of luck with the new venture,


    1. Thanks Michael. Now following you on Twitter!

  3. Thanks Alice. The point you mention was also nicely covered in this recent editorial by Kelly and Prichard at Journal of Clinical Oncology: Personalized Medicine: What Exactly Is It and Can We Truly Measure It?

    The same diagnosis for the same disease can often result in different treatments, depending on the patient's goals.

  4. I am intrigued and look forward to reading and learning more!

  5. I'm so glad that you decided to start a blog! I look forward to your posts, which are bound to be insightful and thought-provoking :)

    1. I appreciate your vote of confidence, Dana! Thank you!!