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Ajit Alles

I agree with you that this is primarily a marketing tool for the genomics/proteomics brigade. This has come to mean that patients will have personal physician concierges. If we had unlimited funds that might be possible, but without utopia close at hand, the reality is that medicine will be based on statistical norms for the most part. We had a kind of personalized medicine when medicine consisted of the family doctor practicing by himself, but we have rejected that model in an attempt to streamline and rationalize medical treatment. While this has produced good outcomes we have lost the personal interaction with our doctors. We may be able to tailor our therapies, but concierge medicine will only be available to the wealthy. The rest of us will have to lump it.

Brian Jackson


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.


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