Once again, one of the topics at this week's annual meeting of the RSNA in Chicago will be personalized medicine. It's a term on everyone's lips, yet everyone seems to mean something different.
Dr. James H. Thrall, from the Department of Radiology, Massachusetts General Hospital, Boston, described it in 2004 as: "The age of personalized medicine is underway. Each individual is now an 'n' of one."1
Dr. Peter Rinck, PhD, is a professor of diagnostic imaging and the president of the Council of the Round Table Foundation (TRTF) and European Magnetic Resonance Forum (EMRF).Also in 2004, Dr. Henry Wagner, a pioneer in the field of radioisotope imaging, lauded personalized medicine at the annual meeting of the (US-American) Society of Nuclear Medicine: "I envision [a database] where everyone will have a periodically updated portable electronic record that contains lifetime manifestations of his or her state of health," he said. "Rather than trying to give a name to a patient's disease, putting him or her in a disease 'box,' the person's electronic health record will reveal all the 'manifestations' of the patient's health and illness. The manifestations on a patient's 'health chip' can be automatically compared ... to characterize illness, predict what is likely to happen, and suggest possible treatment."2
Personalized medicine is described as an inevitable trend and the personal health chip is closely connected to it.
Detailed systems have been worked out. One was proposed by Dr. Eric Topol in a book about the arrival of personalized medicine published last spring.3 He concentrates on a chip embedded in or attached to patients' bodies. The chip will receive all information about genetically caused, infectious, or other diseases and their response to pharmacological treatment. Based on the patients' complete genome the stored information can be processed and interpreted by their smartphone, which also proposes treatment decisions. Other decisions will be made by the patients themselves, only a few by physicians. In the World Wide Web patients have access to the latest medical information and decide on treatment based on the freely available medical literature -- the author describes this as the "democratization" of medicine.
Topol is convinced that with the knowledge of an individual's complete genetic structure and its variations and mutations from what is believed to be normal, prediction of diseases and their prevention or therapy will be possible and pharmaceutical treatment straightforward. According to his book, it will also "reboot" the pharmaceutical industry.
Dr. Aaron Ciechanover, who received the 2004 Nobel Prize in Chemistry, also has no doubt that custom-tailored therapy will evolve soon4: "Just think of how differently the same cancer can progress in different people. But still they all receive the same treatment -- often with uncertain outcomes."
Ciechanover is more balanced, but he too misses the point: Knowing the cause of a disease does not mean that you can treat it. More so, there are numerous other points usually missed, among them the multiple variations of genetic mutations reflected in traits and the myriad of different additional factors contributing to the outbreak of a disease.
In a letter to Science, Daniel W. Nebert and Ge Zhang enlarge upon the great hopes placed in personalized medicine and individualized drug therapy5. Their article is short, straightforward, scientifically argued, and to the point. They close:"However, the idealistic goal of personalized medicine and individualized drug therapy, which needs a holistic understanding of each individual patient's unique -onomics read-out [i.e., genomics, protenomics, transcriptomics, metabolomics, epigenomics] is most likely unattainable -- by advances in technology alone."
In my opinion, it is also bold arrogance if researchers outside the medical field talk about their new invention of "personalized medicine" -- for centuries, physicians have dealt with their patients in a personal and individual way. They study their patients' history and symptoms and offer their expert advice. Generally, patients get empathy, attention, perhaps even affection from their doctor; they are not just numbers on spreadsheets but human beings.
References
- Thrall JH. Personalized medicine. Radiology. 2004;231:613-616.
- Wagner H. as cited in: SNM News - A thousand words: SNM image of the year demonstrates future of medicine. http://interactive.snm.org/index.cfm?PageID=2630.
- Topol E. The Creative Destruction of Medicine: How the digital revolution will create better health care. New York, NY: Basic Books, 2012.
- Laroche R. Is personalized medicine a prescription for the future? Humboldt Kosmos. 2012;99:8.
- Nebert DW, Zhang G. Personalized medicine: Temper expectations. Science. 2012;337(6097):910-911.
- Rinck PA. Maverinck - Weltfremd is of no value to your patients. AuntMinnieEurope.com. 2 March 2011. http://www.auntminnieeurope.com/index.aspx?sec=nws&sub=rad&pag=dis&ItemID=604789
Dr. Peter Rinck, PhD, is a professor of diagnostic imaging and the president of the Council of the Round Table Foundation (TRTF) and European Magnetic Resonance Forum (EMRF).
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