I have been grappling for many months with an acceptable new definition for personalized medicine and recently raised this topic again in a note (see: Term "Personalized Medicine" More About Business than Healthcare Delivery). Dr. Brian Jackson of ARUP Laboratories frequently comments on my notes and provides remarkable new insights. His most recent comment is no exception. I reproduce it below in its entirety:
I think you're being too narrow when you define personalized medicine as targeted therapy. Though you're much more on the right track than the vast majority of biomedical folks who think it means simply performing whole genome analyses on everyone. Given that we're pathologists, how about we define personalized medicine in terms of the information integration necessary for patient care? The two ends of the spectrum in my mind are population medicine and personalized medicine. Population medicine is essentially EBM. It gets criticized for being cookbook, but the fact is that there is important information value in studying large groups of patients at a time -- think where we'd be if randomized clinical trials didn't exist. At the other end of the spectrum is personalized medicine, i.e. acquiring and integrating more and more patient-specific information. I firmly believe the sweet spot will be when we figure out how to properly balance and take advantage of both population-based information and personalized information and apply that to individual patients.
The problem that I have with Brian's idea, incorporating the notion of personalized medicine with population medicine, is that I don't like the use of the term personalized at all. It's so subject to misinterpretation that I want to abandon it entirely. However, Brian's comment got me thinking that the alternative term that I have been using for personalized medicine, targeted therapy, is too narrow. It fails to take into consideration the use of sophisticated diagnostic tests that I have been constantly emphasizing in Lab Soft News. So, in the process of crafting an expanded definition for personalized medicine, let's start with targeted diagnostics and therapeutics, understanding that many of the emerging biotech drugs would be far less useful if unaccompanied by companion diagnostics. Now, let's build on this work-in-progress by also capturing Brian's ideas about the criticality of integrated care and evidence-based medicine (EBM). They incorporate the experience gained by treating large patient populations and large clinical trials. Here is our new, and complete for now, definition for your consideration:
Personalized Medicine: targeted diagnostics and therapeutics that incorporate the knowledge gained through evidence-based medicine as well as the individual and unique characteristics of the patient being treated.