Personalized Medicine and the Art of Medicine

In everything there are fashions, also in medicine. One of the most commonly used expressions in medicine today is personalized medicine; everyone is talking about it and, it seems, all physicians practice it. So much so that there are medical journals devoted solely and exclusively to “personalized medicine”. But what is personalized medicine, what does it consist of? More prosaically, how do we know if we are being treated according to the principles of personalized medicine?

To begin with, there is no single definition of personalized medicine. In the English language there is an expression that some do not hesitate to apply to “personalized medicine”. The word is buzzword and refers to words or expressions that are fashionable, sound good and are repeated everywhere without their meaning being entirely clear. To complicate matters further, alongside “personalized medicine” other expressions such as “evidence-based medicine”, “precision medicine”, “stratified medicine”, “molecular medicine”, “sequential medicine” or “omic medicine” are used to refer to virtually the same concept.

Treatment best suited to the individual patient

The Medical Dictionary and the National Cancer Institute define “personalized medicine” as that which “takes into account the unique molecular characteristics of the patient and the disease for its treatment” or, more broadly, “that which takes into account the genetic characteristics of individuals, proteins and environmental circumstances to prevent, diagnose and treat diseases, seeking the most appropriate and least toxic treatment for each patient at any given time”.

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The best treatment for each patient, who would object to this? Isn’t this what physicians have been pursuing all along? The current boom in “personalized medicine” applied to oncology is due to progress in the knowledge of tumor biology and the identification of genetic mutations and other markers that predict the evolution of a tumor and whether or not it will respond to a given treatment.

Unfortunately, in medicine there is no 100% reliable prognostic factor. Medicine is the science of uncertainty and the art of probability (William Osler), hence the so-called “uncertainty principle” is part of it. Because of this, clinical practice cannot be based solely on algorithms, clinical guidelines, protocols, expert opinions and other tools, however useful they may be. In fact, the concept of “personalized medicine”, as analyzed so far, constitutes an enormous paradox, since it apparently leaves aside the main raison d’être of medicine, i.e. the sick person, the unique and unrepeatable human being, with his or her concerns, fears and desires. Where has the old aphorism “there are no diseases, only sick people” gone in today’s “personalized medicine”?

How do I know if I am going to be treated according to the dictates of personalized medicine?

If the doctor asks you and listens to you, explores you (not just ordering and looking at diagnostic tests), asks you about your concerns, fears and hopes, you can be sure that you will be treated according to the postulates of true personalized medicine, i.e. medicine in which the “person” is the most important thing. And always of course taking into account the characteristics of the tumor, its biological markers and the latest advances in diagnosis, prognosis and treatment, but not only that.