Personalized medicine. Precision medicine. Genomic medicine. Individualized medicine. All of these phrases strive to express a similar vision—a reality where physicians treat based on each patient’s unique biology. The concept is poised to revolutionize clinical and preventive care. But even as the technologies helping to birth this new breed of medicine mature, the semantics surrounding the phenomenon are still experiencing growing pains.
So, what should we call it? For a long time, “personalized medicine” was the preferred nomenclature. In the popular press especially, this was (and often still is) the go-to phrase to describe the medical paradigm shift that is underway. But about eight years ago, a committee convened by the director of the National Institutes of Health recommended jettisoning “personalized medicine” and replacing it with “precision medicine.” This term, the committee argued, “is less likely to be misinterpreted as meaning that each patient will be treated differently from every other patient.”
For now, the closest we’ve gotten to the distant goal has been bucketing patients into subgroups, most often on the basis of their genetics. “Genomic medicine” characterizes this current state of affairs most directly, but the term seems to ignore other unique characteristics—environmental factors, lifestyle, microbiomes, etc.—that can also be used to tailor a treatment to a particular patient.
This month’s Reading Frames author Eric Topol, founder and director of the Scripps Research Translational Institute, wrote in a 2014 Cell review article that all of these phrases should be left in the dust, advocating for the use of “individualized medicine” in their place. The individual, he argued, is at the epicenter of this new approach to clinical care. “Be it a genome sequence on a tablet or the results of a biosensor for blood pressure or another physiologic metric displayed on a smartphone,” Topol wrote, “the digital convergence with biology will definitively anchor the individual as a source of salient data, the conduit of information flow, and a—if not the—principal driver of medicine in the future.”
The term “individualized medicine” sits just fine with me. The word “personalized” bears whiffs of monogrammed pajamas, and “precision” sounds like what all research and medicine endeavors to be—precise—regardless of their scope. I think the wording matters, because if medicine is to change with the help of the types of research featured in this issue of The Scientist, it requires buy-in from a broad swath of humanity. Not just the sort of people who own monogrammed pajamas.
The word “individualized” focuses the future of clinical care—and the research effort that supports and nurtures it—on the level of the individual, regardless of race, socioeconomic status, or geographic location. By moving away from phrases that undersell the potential of individualized medicine or suggest tailored treatments that will only be available to those who can afford them, we might realize a more inclusive and equitable medical revolution. Although widespread diseases such as cancer, heart disease, and diabetes show discernible differences in prevalence across races, income levels, and geography, this new breed of medicine should not.
Walking into your local hospital or clinic and receiving individualized treatment for commonplace complaints may still be several years off, but issues of inclusivity are important to consider now, as researchers build the databases and infrastructure that undergird the approach. Genomic databases, for example, are notoriously skewed towards people of European descent, which means that they may contribute to widening already worrisome ethnicity-based gaps in health care. This is starting to change, but further increasing inclusivity is necessary to help lay a more robust foundation of data upon which individualized clinical care can be built.
The people you’ll meet in this issue of The Scientist are at the forefront of making individualized medicine a reality. We will continue to track and report on their efforts, and I for one look forward to the day when we can share stories of unprecedented triumph, when patients from all walks of life are able to avail themselves of a new model of clinical research and treatment.