Abstract
In the executive summary of the Personalized Health Care Expert Panel Meeting held on September 10, 2007, prepared for the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, the following was written: “Personalized health care draws from information about differences in individual genomes, molecular- and cellular-level disease processes, health states, behavioral and environmental determinants and response to interventions. It applies this to deliver patient-specific health care that reflects individual risks and benefits of particular treatments, to determine risks of particular conditions or diseases and to facilitate the discovery and validation of health care products and other interventions” (1).
It is noteworthy that the word “personalized” has been used for many years in relation to healthcare. For example, in 1981, long before the formation of The Personalized Medicine Coalition* (2), the article “Need for Personalized Medical Care Apparent Today” appeared in the newspaper The Day (New London, CT), declaring, “we must find a way to meet the public's demands for personalized care that will satisfy social and psychological needs as well as treat disease” (3). This is quite different from the current idea, at least in some circles, of what personalized medical care means, though the sentiments are still current and valid. Decades ago the word “personalized” also appeared in numerous advertisements as well as in the medical literature. “A Personalized Rural Pediatric Service” (4), “Personalized Pre-Partum Care” (5), “A Philosophy of Personalized Care” (6), and “Editorial on Personalized Patient Care” (7) are a few of the titles listed in PubMed prior to 1970. Sometimes the line between medical literature and advertising was blurred, as in the 1979 PubMed title “How to Sell your Personalized Service” (8)!
Unquestionably the use of personalized medicine or personalized health care as proprietary terms was engendered by the revolution in genomics, which came to fruition in the last decade, during which the human genome was sequenced and some of its variants unraveled. Although the executive summary of the Personalized Health Care Expert Panel Meeting also speaks of behavioral and environmental determinants as components of personalized medicine, there is little doubt that the present focus and excitement is on how an individual's genotypic information can be used for optimal care. This focus is needed; despite the spectacular progress to date, medicine is only at the beginning. As the journey progresses, however, the influences of environment, age, sex, epigenetics, and other factors must not be forgotten.
Soon after the turn of the 19th century Henry Ford revolutionized manufacturing by his development of the assembly line. Later it was said that statistician and business consultant W. Edwards Deming “lamented the problem of automation gone awry” (9). It would be interesting, indeed, if Deming were still with us to evaluate today's health care. No doubt he would note that attempts to automate medical care have clashed with the truism that individuals are not all “one size” and therefore not a good substrate for practices dominated by rote. The ATA meeting “Thyroid Disorders in the Era of Personalized Medicine” is one of the alternatives to this. It provides an opportunity for endocrinologists and primary care physicians to energize their practices, returning to their patients with a new appreciation of their diversity.
Footnotes
*
The Personalized Medicine Coalition, a nonprofit advocacy and educational group, was formed in 2004 and “seeks to advance the understanding and adoption of personalized medicine concepts for the benefit of patients.” It represents “a broad spectrum of academic, industrial, patient, provider, and payer communities” (
).