For our website, we have chosen the term “precision medicine” rather than “personalized medicine”. A recent News article in Nature Medicine reinforces this concept (see here).
I have had many of my non-genetic physician colleagues comment to me: “We practice personalized medicine every day. It’s called basic patient care!” Their point: physicians see patients and make decisions about the best course of treatment based on patient preferences. For example, one RA patient may prefer to have a drug infusion once per month and another patient may prefer to take a pill each day.
The Nature Medicine article emphasizes “the idea that molecular information improves the precision with which patients are categorized and treated“. While personalized medicine might say “patient X with disease Y should get drug Z”, precision medicine says “patient X has a subset of disease Y — actually, disease Y3, not disease Y1, Y2 or Y4 — and patients with disease Y tend to respond more favorably to drug Z”. Said another way bt Charles Sawyers, an oncologist at the Memorial Sloan-Kettering Cancer Center in New York: “we are trying to convey a more precise classification of disease into subgroups that in the past have been lumped together because there wasn’t a clear way to discriminate between them“.
In my opinion, one reason for the shift from “personalized medicine” towards another description is the baggage that comes with the phrase personalized medicine. Around the time of the completion of the human genome project in 2000, there was hope that genetic markers would clearly segment patients into responders and non-responders. However, this has not yet happened, in part because complex traits — including PGx predictors of response to drugs — are highly polygenic (see here).
A more realistic perspective on the role of genetics in patient care is that underscored by the concept of precision medicine. The same physicians who say “we already practice personalized medicine” are the first to admit “we need more precise classification of disease“. For a disease such as RA, many skilled physicians prefer the word “syndrome” over “disease”, to emphasize this point exactly. RA is not one disease; rather, it is a collection of distinct but overlapping diseases which make up a crude category we current call rheumatoid arthritis. Intuitively, most physicians believe that if we could understand these disease subsets, then we could treat patients more effectively by picking the right medications (most of the time, but not all of the time) and predicting the right outcomes (with greater precision).
In 2011, a group convened by the National Academy of Sciences published a 142-page report entitled “Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease” (see here and download PDF here). The “new taxonomy” that emerges would define diseases by their underlying molecular causes and other factors in addition to their traditional physical signs and symptoms. The report adds that the new data network could also improve biomedical research by enabling scientists to access patients’ information during treatment while still protecting their rights. This would allow the marriage of molecular research and clinical data at the point of care, as opposed to research information continuing to reside primarily in academia.
For these reasons and more, my lab prefers the term “precision medicine” over “personalized medicine”.