Challenge of personalized health care: To what extent is medicine already individualized and what are the future trends?

Author: Walter FierzPresented by Xiaomin Xu

For Journal Club on Sep.13,2005

Backgound Before the advent of scientific

medicine Lack of standardization Individualize medical care

Introduction of the scientific medicine Personal aspects of treatment were

endangered Challenge: regain individualism on a

scientific basis

Personalized medicine Occurred at post-genomic era Individualized medicine is not new New are: Molecular diagnostics based

on comprehensive and high-throughput genetic testing & pharmacogenomics

Focus of this article: infectious diseases and clinical immunological disorders

Six dimensions of PM Disease: disease evolution Environment: the infecting microbe Genes: the molecular traits and

mechanisms underlying the individual characteristics of both the patient and the microbe

Six dimensions of PM (Cont.) Medication: drug development Health care: health-care process Information management: patient-

specific and knowledge-based Properties along these six

dimensions are not independent from each other

Individual character of infectious diseases Interaction between host and

microbes is very individual Individuality: based on many

factors Molecular technology has been

introduced into the third dimension

Individual character of immune responses Innate immune system and

adaptive immune system both show high degree of polymorphism

Overwhelming complexity of the immune system make personalizing prevention and treatment difficult

Within health care process Personalized medicine and patient-centered

care are mutually supportive. Put emphasis on the integration of

disparate personalized medical approaches and on the integration of fragmented personal records.

Personalized information management Clinical laboratory should provide electronic

links between personal lab data and electronic information from digital libraries and databases.

Social and ethical risks Personal values are at stake: privacy,

protection of minorities, prevention of discrimination

Regulation: Inform consent in the diagnostic process Clinical lab as trusted intermediaries Legal protection Protect genetic minorities Rational and irrational discrimination

Conclusions Personalized medicine is promising Challenge is to adapt the health-

care process to the needs of personalized medicine and to cope with its social risks