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Malsch AKF, Killin A, Kaiser MI. Health-Oriented Environmental Categories, Individual Health Environments, and the Concept of Environment in Public Health. HEALTH CARE ANALYSIS 2024; 32:141-164. [PMID: 38285121 PMCID: PMC11133169 DOI: 10.1007/s10728-023-00477-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/30/2024]
Abstract
The term 'environment' is not uniformly defined in the public health sciences, which causes crucial inconsistencies in research, health policy, and practice. As we shall indicate, this is somewhat entangled with diverging pathogenic and salutogenic perspectives (research and policy priorities) concerning environmental health. We emphasise two distinct concepts of environment in use by the World Health Organisation. One significant way these concepts differ concerns whether the social environment is included. Divergence on this matter has profound consequences for the understanding of health and disease, for measures derived from that understanding targeting health promotion and disease prevention, and consequently, for epistemic structures and concept development in scientific practice. We hope to improve the given situation in public health by uncovering these differences and by developing a fruitful way of thinking about environment. Firstly, we side with the salutogenic conception of environment as a health resource (as well as a source of health risks). Secondly, we subdivide the concept of environment into four health-oriented environmental categories (viz., natural, built-material, socio-cultural, and psychosocial) and we link these with other theoretical notions proposed in the health sciences literature. Thirdly, we propose that in public health 'environment' should be understood as consisting of all extrinsic factors that influence or are influenced by the health, well-being, and development of an individual. Consequently, none of the four categories should be excluded from the concept of environment. We point out the practical relevance and fruitfulness of the conception of environment as a health source and frame this in causal terms, representing individual health environments as causal networks. Throughout, we side with the view that for the design of human health-promoting settings, increased attention and consideration of environmental resources of salutogenic potential is particularly pressing.
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Affiliation(s)
- Annette K F Malsch
- Faculty of Health Sciences, AG7 Environment and Health, Bielefeld University, Universitätsstraβe 25, 33501, Bielefeld, Germany.
- Joint Institute for Individualisation in a Changing Environment, University of Münster and Bielefeld University, Münster and Bielefeld, Germany.
| | - Anton Killin
- Department of Philosophy, Bielefeld University, Bielefeld, Germany
- Joint Institute for Individualisation in a Changing Environment, University of Münster and Bielefeld University, Münster and Bielefeld, Germany
| | - Marie I Kaiser
- Department of Philosophy, Bielefeld University, Bielefeld, Germany
- Joint Institute for Individualisation in a Changing Environment, University of Münster and Bielefeld University, Münster and Bielefeld, Germany
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Chiapperino L, Besle S, Louvel S, Panese F. Editorial: Personalized health and precision medicine in practice. FRONTIERS IN SOCIOLOGY 2024; 9:1367791. [PMID: 38444604 PMCID: PMC10913194 DOI: 10.3389/fsoc.2024.1367791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/05/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Luca Chiapperino
- STS Lab, Institute of Social Sciences, Faculty of Social and Political Sciences, Université de Lausanne, Lausanne, Switzerland
| | - Sylvain Besle
- Centre de Recherche en Cancérologie de Lyon, INSERM U1052-CNRS UMR5286, Centre Léon Bérard, Université de Lyon, Université Claude Bernard Lyon1, Lyon, France
| | - Séverine Louvel
- Université Grenoble Alpes, CNRS, Sciences Po Grenoble, Pacte, Grenoble, France
| | - Francesco Panese
- STS Lab, Institute of Social Sciences, Faculty of Social and Political Sciences, Université de Lausanne, Lausanne, Switzerland
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Skovgaard L, Grundtvig A. Who tweets what about personalised medicine? Promises and concerns from Twitter discussions in Denmark. Digit Health 2023; 9:20552076231169832. [PMID: 37113257 PMCID: PMC10126701 DOI: 10.1177/20552076231169832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/29/2023] [Indexed: 04/29/2023] Open
Abstract
Digital health data are seen as valuable resources for the development of better and more efficient treatments, for instance through personalised medicine. However, health data are information about individuals who hold opinions and can challenge how data about them are used. Therefore it is important to understand public discussions around reuse of digital health data. Social media have been heralded as enabling new forms of public engagement and as a place to study social issues. In this paper, we study a public debate on Twitter about personalised medicine. We explore who participates in discussions about personalised medicine on Twitter and what they tweet about. Based on user-generated biographies we categorise users as having a 'Professional interest in personalised medicine' or as 'Private' users. We describe how users within the field tweet about the promises of personalised medicine, while users unaffiliated with the field tweet about the concrete realisation of these ambitions in the form of a new infrastructure and express concerns about the conditions for the implementation. Our study serves to remind people interested in public opinion that Twitter is a platform used for multiple purposes by different actors and not simply a bottom-up democratic forum. This study contributes with insights relevant to policymakers wishing to expand infrastructures for reuse of health data. First, by providing insights into what is discussed about health data reuse. Second, by exploring how Twitter can be used as a platform to study public discussions about reuse of health data.
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Affiliation(s)
- Lea Skovgaard
- Department of Public Health, University of
Copenhagen, Copenhagen K, Denmark
- Lea Skovgaard, Department of Public Health,
University of Copenhagen, Øster Farigmagsgade 5, Copenhagen K 1014, Denmark.
| | - Anders Grundtvig
- Department of Public Health, University of
Copenhagen, Copenhagen K, Denmark
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Amekyeh H, Tarlochan F, Billa N. Practicality of 3D Printed Personalized Medicines in Therapeutics. Front Pharmacol 2021; 12:646836. [PMID: 33912058 PMCID: PMC8072378 DOI: 10.3389/fphar.2021.646836] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/02/2021] [Indexed: 11/13/2022] Open
Abstract
Technological advances in science over the past century have paved the way for remedial treatment outcomes in various diseases. Pharmacogenomic predispositions, the emergence of multidrug resistance, medication and formulation errors contribute significantly to patient mortality. The concept of "personalized" or "precision" medicines provides a window to addressing these issues and hence reducing mortality. The emergence of three-dimensional printing of medicines over the past decades has generated interests in therapeutics and dispensing, whereby the provisions of personalized medicines can be built within the framework of producing medicines at dispensaries or pharmacies. This plan is a good replacement of the fit-for-all modality in conventional therapeutics, where clinicians are constrained to prescribe pre-formulated dose units available on the market. However, three-dimension printing of personalized medicines faces several hurdles, but these are not insurmountable. In this review, we explore the relevance of personalized medicines in therapeutics and how three-dimensional printing makes a good fit in current gaps within conventional therapeutics in order to secure an effective implementation of personalized medicines. We also explore the deployment of three-dimensional printing of personalized medicines based on practical, legal and regulatory provisions.
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Affiliation(s)
- Hilda Amekyeh
- Department of Pharmaceutics, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | | | - Nashiru Billa
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
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Valent P, Orfao A, Kubicek S, Staber P, Haferlach T, Deininger M, Kollmann K, Lion T, Virgolini I, Winter G, Hantschel O, Kenner L, Zuber J, Grebien F, Moriggl R, Hoermann G, Hermine O, Andreeff M, Bock C, Mughal T, Constantinescu SN, Kralovics R, Sexl V, Skoda R, Superti-Furga G, Jäger U. Precision Medicine in Hematology 2021: Definitions, Tools, Perspectives, and Open Questions. Hemasphere 2021; 5:e536. [PMID: 33623882 PMCID: PMC7892291 DOI: 10.1097/hs9.0000000000000536] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/16/2020] [Indexed: 12/20/2022] Open
Abstract
During the past few years, our understanding of molecular mechanisms and cellular interactions relevant to malignant blood cell disorders has improved substantially. New insights include a detailed knowledge about disease-initiating exogenous factors, endogenous (genetic, somatic, epigenetic) elicitors or facilitators of disease evolution, and drug actions and interactions that underlie efficacy and adverse event profiles in defined cohorts of patients. As a result, precision medicine and personalized medicine are rapidly growing new disciplines that support the clinician in making the correct diagnosis, in predicting outcomes, and in optimally selecting patients for interventional therapies. In addition, precision medicine tools are greatly facilitating the development of new drugs, therapeutic approaches, and new multiparametric prognostic scoring models. However, although the emerging roles of precision medicine and personalized medicine in hematology and oncology are clearly visible, several questions remain. For example, it remains unknown how precision medicine tools can be implemented in healthcare systems and whether all possible approaches are also affordable. In addition, there is a need to define terminologies and to relate these to specific and context-related tools and strategies in basic and applied science. To discuss these issues, a working conference was organized in September 2019. The outcomes of this conference are summarized herein and include a proposal for definitions, terminologies, and applications of precision and personalized medicine concepts and tools in hematologic neoplasms. We also provide proposals aimed at reducing costs, thereby making these applications affordable in daily practice.
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Affiliation(s)
- Peter Valent
- Department of Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Austria
| | - Alberto Orfao
- Servicio Central de Citometria, Centro de Investigacion del Cancer (IBMCC; CSIC/USAL), IBSAL, CIBERONC and Department of Medicine, University of Salamanca, Spain
| | - Stefan Kubicek
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Philipp Staber
- Department of Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Austria
| | | | - Michael Deininger
- Division of Hematology and Hematologic Malignancies, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Karoline Kollmann
- Institute of Pharmacology and Toxicology, University of Veterinary Medicine Vienna, Austria
| | - Thomas Lion
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Austria
- Children’s Cancer Research Institute, Vienna, Austria
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University of Innsbruck, Austria
| | - Georg Winter
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Oliver Hantschel
- Institute of Physiological Chemistry, Faculty of Medicine, Philipps-University of Marburg, Germany
| | - Lukas Kenner
- Pathology of Laboratory Animals, University of Veterinary Medicine, Vienna, Austria
| | - Johannes Zuber
- Research Institute of Molecular Pathology (IMP), Vienna, Austria
| | - Florian Grebien
- Institute for Medical Biochemistry, University of Veterinary Medicine Vienna, Austria
| | - Richard Moriggl
- Institute of Animal Breeding and Genetics, Unit for Functional Cancer Genomics, University of Veterinary Medicine Vienna, Austria
| | - Gregor Hoermann
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Austria
- MLL Munich Leukemia Laboratory, Munich, Germany
| | - Olivier Hermine
- Imagine Institute Université Paris Descartes, Sorbonne, Paris Cité, Paris, France
- Department of Hematology, Necker Hospital, Paris, France
| | - Michael Andreeff
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christoph Bock
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Tariq Mughal
- Division of Hematology & Oncology, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Stefan N. Constantinescu
- de Duve Institute and Ludwig Cancer Research Brussels, Université catholique de Louvain, Brussels, Belgium
| | - Robert Kralovics
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Veronika Sexl
- Institute of Pharmacology and Toxicology, University of Veterinary Medicine Vienna, Austria
| | - Radek Skoda
- Departement of Biomedicine, University of Basel, Switzerland
| | - Giulio Superti-Furga
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Ulrich Jäger
- Department of Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Austria
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Boissonneau S, Graillon T, Rolland A, Botella C, Pallud J, Dufour H. Management of patients suffering from hemorrhagic intracranial metastases: Propositions to help the neurosurgeon in emergency situations based on a literature review. Neurochirurgie 2020; 67:369-374. [PMID: 33232711 DOI: 10.1016/j.neuchi.2020.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 09/09/2020] [Accepted: 11/14/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Brain metastases are the most common intracranial neoplasm in adult patients, and one of the fearsome complications proves to be intratumoral hemorrhage. The neurosurgical management of patients harboring a bleeding brain metastasis is not fully established and there is still today an ongoing debate on the optimal management of these patients. The aim of this article is to provide the neurosurgeons with practical tools to assist in their decision-making process in the management of BMs. METHODS We conducted a literature review of the relevant Pubmed, Cochrane, and Google scholar-indexed articles published between 2000 and 2019. The following key words were entered in the Pubmed search engine: [metastasis], [metastases], [brain metastases], [brain metastasis], [hemorrhage], [hematoma], [blood clot], [intracerebral hemorrhage], [intracranial hemorrhage]. The review was performed in accordance with the PRISMA recommendations. RESULTS Based on PubMed, Cochrane, and Google scholar, 459 articles were retained, 392 were then removed because of their non-adequacy with the topic and, 9 articles were removed because they were not written in English language. So, 58 articles were analyzed. Radiological evaluation is crucial, but few traps exist. The frequency of overall brain tumor-related with intracranial hematoma is 7.2%, with a higher frequency for secondary tumors. The local recurrence rate after resection of a hemorrhagic metastasis seems to be better probably because of an easier "en bloc" resection thanks to the hematoma. An atypical presentation is reported in up to 4% in patients with chronic or acute subdural hematoma. Patients with subarachnoid hemorrhage and epidural hematoma are rare. A clear-cut correlation between the incidence of bleeding event in brain mets and prior stereotactic radiosurgery was not established. CONCLUSION The current literature pertaining to the neurosurgical management of acute bleeding in brain metastasis is scant and the level of evidence remains low (experts 'opinions; class C). Herein we suggest a flowchart to assist in dealing with those difficult patients.
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Affiliation(s)
- S Boissonneau
- Aix-Marseille Université, AP-HM, CHU Timone, Department of Neurosurgery, Marseille, France; Inserm, INS, Institute of Neurosciences of Systems, Aix Marseille Univ, Marseille, France.
| | - T Graillon
- Aix-Marseille Université, AP-HM, CHU Timone, Department of Neurosurgery, Marseille, France; Aix-Marseille Université, inserm, MMG, Marseille, France
| | - A Rolland
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - C Botella
- Department of Neurosurgery, Centre Hospitalier Saint Anne, Paris, France
| | - J Pallud
- Department of Neurosurgery, Centre Hospitalier Saint Anne, Paris, France; UMR 1266 inserm, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - H Dufour
- Aix-Marseille Université, AP-HM, CHU Timone, Department of Neurosurgery, Marseille, France; Aix-Marseille Université, inserm, MMG, Marseille, France
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Abettan C, Welie JVM. The impact of twenty-first century personalized medicine versus twenty-first century medicine's impact on personalization. Philos Ethics Humanit Med 2020; 15:11. [PMID: 33203434 PMCID: PMC7672902 DOI: 10.1186/s13010-020-00095-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 10/11/2020] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Over the past decade, the exponential growth of the literature devoted to personalized medicine has been paralleled by an ever louder chorus of epistemic and ethical criticisms. Their differences notwithstanding, both advocates and critics share an outdated philosophical understanding of the concept of personhood and hence tend to assume too simplistic an understanding of personalization in health care. METHODS In this article, we question this philosophical understanding of personhood and personalization, as these concepts shape the field of personalized medicine. We establish a dialogue with phenomenology and hermeneutics (especially with E. Husserl, M. Merleau-Ponty and P. Ricoeur) in order to achieve a more sophisticated understanding of the meaning of these concepts We particularly focus on the relationship between personal subjectivity and objective data. RESULTS We first explore the gap between the ideal of personalized healthcare and the reality of today's personalized medicine. We show that the nearly exclusive focus of personalized medicine on the objective part of personhood leads to a flawed ethical debate that needs to be reframed. Second, we seek to contribute to this reframing by drawing on the phenomenological-hermeneutical movement in philosophy. Third, we show that these admittedly theoretical analyses open up new conceptual possibilities to tackle the very practical ethical challenges that personalized medicine faces. CONCLUSION Finally, we propose a reversal: if personalization is a continuous process by which the person reappropriates all manner of objective data, giving them meaning and thereby shaping his or her own way of being human, then personalized medicine, rather than being personalized itself, can facilitate personalization of those it serves through the data it provides.
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Affiliation(s)
- Camille Abettan
- Center of Interdisciplinary Researches in Human and Social Sciences (CRISES, EA 4424), Paul Valéry University, Rue du Professeur Henri Serre, 34090 Montpellier, France
| | - Jos V. M. Welie
- University College Maastricht, Zwingelput 4, 6211KH, Maastricht, Netherlands
- Department of Interdisciplinary Studies, Graduate School, Creighton University, 2500 California Plaza, Omaha, NE 68178 USA
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Aron DC. Precision medicine in an imprecise and complex world: Magic bullets, hype, and the fuzzy line between health and disease. J Eval Clin Pract 2020; 26:1534-1538. [PMID: 31863633 DOI: 10.1111/jep.13306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/08/2019] [Indexed: 12/14/2022]
Affiliation(s)
- David Clark Aron
- Interprofessional Improvement Research Evaluation and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.,School of Medicine, Case Western Research University, Cleveland, Ohio
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Hoeyer K. Data as promise: Reconfiguring Danish public health through personalized medicine. SOCIAL STUDIES OF SCIENCE 2019; 49:531-555. [PMID: 31272287 DOI: 10.1177/0306312719858697] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
'Personalized medicine' might sound like the very antithesis of population science and public health, with the individual taking the place of the population. However, in practice, personalized medicine generates heavy investments in the population sciences - particularly in data-sourcing initiatives. Intensified data sourcing implies new roles and responsibilities for patients and health professionals, who become responsible not only for data contributions, but also for responding to new uses of data in personalized prevention, drawing upon detailed mapping of risk distribution in the population. Although this population-based 'personalization' of prevention and treatment is said to be about making the health services 'data-driven', the policies and plans themselves use existing data and evidence in a very selective manner. It is as if data-driven decision-making is a promise for an unspecified future, not a demand on its planning in the present. I therefore suggest interrogating how 'promissory data' interact with ideas about accountability in public health policies, and also with the data initiatives that the promises bring about. Intensified data collection might not just be interesting for what it allows authorities to do and know, but also for how its promises of future evidence can be used to postpone action and sidestep uncomfortable knowledge in the present.
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Affiliation(s)
- Klaus Hoeyer
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Erikainen S, Chan S. Contested futures: envisioning "Personalized," "Stratified," and "Precision" medicine. NEW GENETICS AND SOCIETY 2019; 38:308-330. [PMID: 31708685 PMCID: PMC6817325 DOI: 10.1080/14636778.2019.1637720] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 05/22/2019] [Indexed: 05/25/2023]
Abstract
In recent years, discourses around "personalized," "stratified," and "precision" medicine have proliferated. These concepts broadly refer to the translational potential carried by new data-intensive biomedical research modes. Each describes expectations about the future of medicine and healthcare that data-intensive innovation promises to bring forth. The definitions and uses of the concepts are, however, plural, contested and characterized by diverse ideas about the kinds of futures that are desired and desirable. In this paper, we unpack key disputes around the "personalized," "stratified," and "precision" terms, and map the epistemic, political and economic contexts that structure them as well as the different roles attributed to patients and citizens in competing future imaginaries. We show the ethical and value baggage embedded within the promises that are manufactured through terminological choices and argue that the context and future-oriented nature of these choices helps to understanding how data-intensive biomedical innovations are made socially meaningful.
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Affiliation(s)
- Sonja Erikainen
- Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Sarah Chan
- Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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Walker MJ, Bourke J, Hutchison K. Evidence for personalised medicine: mechanisms, correlation, and new kinds of black box. THEORETICAL MEDICINE AND BIOETHICS 2019; 40:103-121. [PMID: 30771062 DOI: 10.1007/s11017-019-09482-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Personalised medicine (PM) has been discussed as a medical paradigm shift that will improve health while reducing inefficiency and waste. At the same time, it raises new practical, regulatory, and ethical challenges. In this paper, we examine PM strategies epistemologically in order to develop capacities to address these challenges, focusing on a recently proposed strategy for developing patient-specific models from induced pluripotent stem cells (iPSCs) so as to make individualised treatment predictions. We compare this strategy to two main PM strategies-stratified medicine and computational models. Drawing on epistemological work in the philosophy of medicine, we explain why these two methods, while powerful, are neither truly personalised nor, epistemologically speaking, novel strategies. Both are forms of correlational black box. We then argue that the iPSC models would count as a new kind of black box. They would not rely entirely on mechanistic knowledge, and they would utilise correlational evidence in a different way from other strategies-a way that would enable personalised predictions. In arguing that the iPSC models would present a novel method of gaining evidence for clinical practice, we provide an epistemic analysis that can help to inform the practical, regulatory, and ethical challenges of developing an iPSC system.
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Affiliation(s)
- Mary Jean Walker
- Monash University, Clayton, VIC, Australia.
- Australian Research Council Centre of Excellence for Electromaterials Science, Wollongong, NSW, Australia.
| | - Justin Bourke
- University of Melbourne, Parkville, VIC, Australia
- Australian Research Council Centre of Excellence for Electromaterials Science, Wollongong, NSW, Australia
| | - Katrina Hutchison
- Macquarie University, North Ryde, NSW, Australia
- Australian Research Council Centre of Excellence for Electromaterials Science, Wollongong, NSW, Australia
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Wiesing U. From art to science: a new epistemological status for medicine? On expectations regarding personalized medicine. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2018; 21:457-466. [PMID: 29264706 DOI: 10.1007/s11019-017-9820-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Personalized medicine plays an important role in the development of current medicine. Among the numerous statements regarding the future of personalized medicine, some can be found that accord medicine a new scientific status. Medicine will be transformed from an art to a science due to personalized medicine. This prognosis is supported by references to models of historical developments. The article examines what is meant by this prognosis, what consequences it entails, and how feasible it is. It refers to the long tradition of epistemological thinking in medicine and the use of historical models for the development of medicine. The possible answers to the question "art or science" are systematized with respect to the core question about the relationship between knowledge and action. The prediction for medicine to develop from an 'empirical healing art' to a 'rational, molecular science' is nonsensical from an epistemological point of view. The historical models employed to substantiate the development of personalized medicine are questionable.
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Affiliation(s)
- Urban Wiesing
- Institute for Ethics and the History of Medicine, University of Tübingen, Gartenstr. 47, 72074, Tübingen, Germany.
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Moerenhout T, Devisch I, Cornelis GC. E-health beyond technology: analyzing the paradigm shift that lies beneath. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2018; 21:31-41. [PMID: 28551772 DOI: 10.1007/s11019-017-9780-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Information and computer technology has come to play an increasingly important role in medicine, to the extent that e-health has been described as a disruptive innovation or revolution in healthcare. The attention is very much focused on the technology itself, and advances that have been made in genetics and biology. This leads to the question: What is changing in medicine today concerning e-health? To what degree could these changes be characterized as a 'revolution'? We will apply the work of Thomas Kuhn, Larry Laudan, Michel Foucault and other philosophers-which offers an alternative understanding of progress and revolution in medicine to the classic discovery-oriented approach-to our analysis. Nowadays, the long-standing curative or reactive paradigm in medicine is facing a crisis due to an aging population, a significant increase in chronic diseases and the development of more expensive diagnostic tools and therapies. This promotes the evolution towards a new paradigm with an emphasis on preventive medicine. E-health constitutes an essential part of this new paradigm that seeks to solve the challenges presented by an aging population, skyrocketing costs and so forth. Our approach changes the focus from the technology itself toward the underlying paradigm shift in medicine. We will discuss the relevance of this approach by applying it to the surge in digital self-tracking through health apps and wearables: the recognition of the underlying paradigm shift leads to a more comprehensive understanding of self-tracking than a solely discovery-oriented or technology-focused view can provide.
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Affiliation(s)
- Tania Moerenhout
- Department of Family Medicine and Primary Health Care, Research Unit Ethics, Autonomy and Responsibility in Health Care, University of Gent, De Pintelaan 185 - Building 6K3, 9000, Ghent, Belgium.
- Department of Philosophy and Moral Sciences, University of Gent, Blandijnberg 2, 9000, Ghent, Belgium.
- Visiting Researcher at the Center for Bioethics and Health Law, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Ignaas Devisch
- Department of Family Medicine and Primary Health Care, Research Unit Ethics, Autonomy and Responsibility in Health Care, University of Gent, De Pintelaan 185 - Building 6K3, 9000, Ghent, Belgium
| | - Gustaaf C Cornelis
- Department of Philosophy and Moral Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Ixelles, Belgium
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De Grandis G, Halgunset V. Conceptual and terminological confusion around personalised medicine: a coping strategy. BMC Med Ethics 2016; 17:43. [PMID: 27431285 PMCID: PMC4950113 DOI: 10.1186/s12910-016-0122-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/07/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The idea of personalised medicine (PM) has gathered momentum recently, attracting funding and generating hopes as well as scepticism. As PM gives rise to differing interpretations, there have been several attempts to clarify the concept. In an influential paper published in this journal, Schleidgen and colleagues have proposed a precise and narrow definition of PM on the basis of a systematic literature review. Given that their conclusion is at odds with those of other recent attempts to understand PM, we consider whether their systematic review gives them an edge over competing interpretations. DISCUSSION We have found some methodological weaknesses and questionable assumptions in Schleidgen and colleagues' attempt to provide a more specific definition of PM. Our perplexities concern the lack of criteria for assessing the epistemic strength of the definitions that they consider, as well as the logical principles used to extract a more precise definition, the narrowness of the pool from which they have drawn their empirical data, and finally their overlooking the fact that definitions depend on the context of use. We are also worried that their ethical assumption that only patients' interests are legitimate is too simplistic and drives all other stakeholders' interests-including those that are justifiable-underground, thus compromising any hope of a transparent and fair negotiation among a plurality of actors and interests. CONCLUSION As an alternative to the shortcomings of attempting a semantic disciplining of the concept we propose a pragmatic approach. Rather than considering PM to be a scientific concept in need of precise demarcation, we look at it as an open and negotiable concept used in a variety of contexts including at the level of orienting research goals and policy objectives. We believe that since PM is still more an ideal than an achieved reality, a plurality of visions is to be expected and we need to pay attention to the people, reasons and interests behind these alternative conceptions. In other words, the logic and politics of PM cannot be disentangled and disagreements need to be tackled addressing the normative and strategic conflicts behind them.
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Affiliation(s)
- Giovanni De Grandis
- Department of Philosophy and Religious Studies, Norwegian University of Science and Technology, NTNU Dragvoll, 7491, Trondheim, Norway.
| | - Vidar Halgunset
- Department of Philosophy and Religious Studies, Norwegian University of Science and Technology, NTNU Dragvoll, 7491, Trondheim, Norway
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