Talk:Personalized medicine

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copied from Theranostics article[edit]

The above definition makes no sense. The term "theranostic" is more frequently used to denote linking of a diagnostic to therapeutic. The second half of the word "nostic" is supposed to represent diagnostic but sounds more like "gnostic", a word introduced into English from Greek and meaning "having a knowledge of". Theranostic could thus mean having knowledge of therapy. Moreover "theranostic" is confusing and not understood by most people and should be deleted from the vocabulary. There is no difficulty in describing this concept without using a special term. Diagnostics used to guide therapeutics are also called “companion diagnostics”. If one has to use a single word to describe a test linked to therapy, one can use "pharmacodiagnostic", which is more appropriate and easy to understand.

Although using this term has been criticized as less than accurate, the above definition does seem to be in line with today's personalized approach to medicine, especially as it relates to cancer treatment. The stakes have never been higher to know that the drug therapy is working in real time than with cancer. Tumor responsiveness is critical to successful treatment and the term used to describe the process of making clinical treatment decisions mid-therapy in direct response to that precise therapy is theranostics.


Jain KK. Textbook of Personalized Medicine, Springer, 2009. — Preceding unsigned comment added by Ettuquoque (talkcontribs) 03:18, 13 January 2012 (UTC)

"Genius"??[edit]

I think labeling a group of scientists and saying "employing the genius of ..." is a pretty clearly biased statement. They employed a bunch of scientists, fine, say that, but the word "genius" implies something about the problem - has anyone somehow done the research to show that these people are all very very smart? It seems like an unnecesarry term, in any event. —Preceding unsigned comment added by 128.189.132.69 (talk) 06:11, 29 November 2007 (UTC)

Gleevec[edit]

I disagree that use of imatinib mesylate (the real name of Gleevec) constitutes "personalised medicine". This is targeted therapy, but that is not the same as the loaded and horrible term "personalised medicine". It would be if every CML patient had his bcr/abl checked for particular resistance mutations and assigned imatinib, nilotinib or dasatinib as per the findings. That is not the case. JFW | T@lk 16:32, 27 September 2006 (UTC)

Unfortunately, I have to disagree with the previous post. Pesonalized medicine is about the right treatment, the right prevention, the right medicine, for the right person. Gleevec is a targeted therapy, in that it only works on "the right type" of cancer. Moreover it goes directly to the heart of what personalized medicine is. It is the moleculary evaluated patient, with the molecularly evaluated disease, and the molecularly designed treatment. Case in point: Gleevec, Tarceva, Amplichip all have pathophysiology molecularly evaluated, with molecularly evaluated patients, and although sometimes the medicines are used inappropriately by uneducated physicians, the majority are used appropriately on the the "right person". Most CML in the US is evaluated for the BCR-ABL fusion gene. Perhaps not in other countries, but absolutely in the US. So it should be included here. SARM | T@lk 09:32, 08 December 2006 (UTC)

I agree with JFW. Gleevec seems a lot closer to targeted therapy than to personalized medicine. I feel the same about Herceptin's inclusion. Under SARM's rather expansive definition of personalized medicine, you'd have to include HAART protocol changes based on viral resistance tests, and antibiotic selection based on what the bacteria seemed resistant to in culture. I don't think that anything which isn't one-size-fits-all should be lumped into "personalized medicine." WhatamIdoing (talk) 16:25, 7 December 2007 (UTC)
I definitely agree with JFW and WhatamIdoing. "Personalized medicine" is more of a buzz word and marketing tool than an actual medical reality. Medical geneticist (talk) 11:43, 10 August 2008 (UTC)

'Stakeholder response'[edit]

Parts of this section feel to me like they're kinda choppy in terms of language and syntax. Also, the 'Patients' and 'Genetic Discrimination' headings seemingly disagree on whether the public seems to support genetic testing or not. Needs some clarification.

I didn't wanna edit it myself without saying something first. :-) 70.119.253.214 06:52, 3 November 2007 (UTC)

Limitations of "Personalized Medicine"[edit]

This whole article seems biased to me. To say that one can make predictive statements about an individual based on what is learned about genetic variants in large populations is a fallacy. What was learned from the sequencing of Watson and Venter? That they had risks (on the basis of genetic variants) for medical conditions they already knew they had risks for (on the basis of family history). Proponents of "Personalized medicine" -- in the context of performing predictive DNA testing in healthy individuals to determine risk -- fail to recognize that unless you know which variants are actually responsible for disease and resistance to disease within a family it is extremely problematic to assign an adjusted risk based on an individual's molecular profile.

For example, imagine that your father had high cholesterol and a heart attack. You are at increased risk for high cholesterol and heart disease, simply on the basis of your family history. So, you go to your neighborhood SNP sequencing company, fork over a pile of money, and they tell you: you have SNPs A, B, and C, so your risk of heart disease is X%. What if your father had SNPs D and E? The more useful information would be to know whether you had inherited SNPs D and E, which are the variants that are most likely to be associated with disease in your family. What if your mother actually has a protective SNP? Again, it is more useful to know the variants in your own biological context. If these private variants aren't tested for in the commercial "personalized medicine" SNP profiles, then you gain no useful information.

Also, it is completely untested whether adding "predictive" genetic information will actually change an individual's likelihood of participating in preventive measures that are already proven to improve health outcomes. In fact, it is conceivable that a result on a "predictive" genetic test could worsen compliance with interventions such as diet, exercise, and moderation with regard to alcohol/tobacco/drugs. If a person is given a "predictive" genetic test result that suggests decreased risk for high cholesterol, might they subconsciously or consciously take this as license to splurge a little, thereby worsening their health with regard to other conditions (obesity, diabetes, cancer)? If a person is given an increased risk, might they take a fatalistic attitude that nothing can be done about it?

The point is that the research hasn't been done to know whether "predictive" testing is any better than taking a good family history and recommending uniform, simple interventions -- eat better, exercise better, sleep more, drink less, smoke less(or not at all), practice safe sex, etc. It's just that "personalized medicine" is a much sexier buzz word than "family practice" or "medical genetics".Medical geneticist (talk) 12:12, 10 August 2008 (UTC)

Starting a major revision[edit]

I got too peeved about the lack of NPOV in the previous version and have started a re-write. I'm happy to incorporate any suggestions/recommendations. Medical geneticist (talk) 15:39, 20 August 2008 (UTC)

Hopeless[edit]

"Personalized medicine" is a silly new catchphrase for something that is as old as Santa's beard. It must have been invented by someone with no connection to real medicine, or how else could the inventor not have been aware that medicine has always been "personalized". Of course clinicians have in the past and will in the future exploit new diagnostic methods to further fine-tune therapy to each of their patients. Genetic methods are useful, but not unique or novel in this regard.

The stupid thing about catch phrases like these - "proteome" is another pet peeve of mine - is that people like the authors of this article, who hear them, then run off and try to make them meaningful. They aren't. A real encyclopedia would indicate as much by ignoring them or offering a very terse expansion. Reminds me of Haecker, who said about Hegel and his followers:"The secret of their success consists in the fact that everyone who is brazen enough may join in." So it is with wikipedia: Popular but hopelessly distracting. If you really want to learn and understand, avoid it. —Preceding unsigned comment added by 129.97.47.64 (talk) 21:19, 23 December 2008 (UTC)

You are absolutely correct that "Personalized medicine" is an invented term that seems to imply a radical change in the way medicine is practiced but in reality is used more often as a marketing strategy than an approach to clinical medicine. Medicine was probably much more "personalized" back in the days when doctors treated their patients in exchange for goods or services and the whole business wasn't swamped by profit margins... However, as much as you (and myself as well) may bristle at the use of the term and whether it is meaningful or not, the fact is that the term IS being used and marketed. The general public wants to know what it means and how it will benefit them, and I think that it is quite reasonable to have a detailed Wikipedia entry on the topic, since it's the first page a Google seach is going to bring up.
Clearly the article prompted a very strong response from you, but rather than just ranting about the term, please help us improve the article by brazenly (or in Wiki terms, BOLDLY) clicking the "edit this page" tab and making it better. That's what I did when I first saw the page and it sounded like someone's business school essay on the subject, where the main part of the article was about "stakeholders" and "key enablers". Look at the history and see how far the page has come. I've tried to include some of these concerns about whether "personalized medicine" is an improvement on traditional clinical medicine, and at least we're trying to present a balanced viewpoint -- see sentences 3 and 4 of the introductory paragraph. Sure, there's a lot of work to be done, but you can help; and while you're at it, the page on Theodor Haecker needs help, too! :) ---Medical geneticist (talk) 20:58, 24 December 2008 (UTC)
Thanks for the reply, but my feeling is this article is beyond repair and can be improved only by starting from scratch. My version of the article would look just like my comment, only shorter and maybe a little more venomous, and it would be rolled back from the main page in 5 minutes.
Good luck with it anyway.

Not only is the article poorly written, the references are inadequate. An important source of information, the Textbook of Personalized Medicine, published by Springer in September 2009, is not mentioned. —Preceding unsigned comment added by 195.12.43.235 (talk) 06:41, 18 October 2009 (UTC)

I'm working on Medical diagnostics, which is a recognised field that encompasses pretty much all of what is known as "personalised medicine". Would talk a merger be crazy? Ian McDonald (talk) 22:53, 16 October 2013 (UTC)

Epigenetics has to be included- this is revolutionizing biology at present[edit]

Modify the statement into this "However, large cohort studies do not take into account the genetic and epigenetic variability of individuals within a population". In response to your statements above: I don't think this (personalized medicine) is silly- if we are after an excellent individual biological in toto care for anyone personalized medicine is the best approach.. what else? —Preceding unsigned comment added by 216.66.59.41 (talk) 03:53, 14 May 2010 (UTC)

Personalized Medicine Scandal[edit]

At a minimum, a review of the current scandal involving Dr. Anil Potti and associates should be included.

The Potti papers cited as "Further Reading" and associated work are currently under review.

  1. Potti et al. (2006), Genomic Signatures to Guide the Use of Chemotherapeutics, Nature Medicine 12: 1294.
  2. Potti et al. (2006), A genomic strategy to refine prognosis in early-stage non-small-cell lung cancer, New England Journal of Medicine 355: 570

A review of the problems uncovered in the analysis reported in these Potti papers can be found in

Deriving chemosensitivity from cell lines: Forensic bioinformatics and reproducible research in high-throughput biology Keith A. Baggerly and Kevin R. Coombes Source: Ann. Appl. Stat. Volume 3, Number 4 (2009), 1309-1334.

A summary of the issues can be found in the journal "Science"

Science 6 August 2010: Vol. 329. no. 5992, pp. 614 - 615 DOI: 10.1126/science.329.5992.614 News of the Week Cancer Research: As Questions Grow, Duke Halts Trials, Launches Investigation Jennifer Couzin-Frankel

An "Expression of Concern" was issued by Lancet Editor Dr. David Collingridge, see

Expression of concern—validation of gene signatures that predict the response of breast cancer to neoadjuvant chemotherapy: a substudy of the EORTC 10994/BIG 00-01 clinical trial David Collingridge The Lancet Oncology - 1 September 2010 ( Vol. 11, Issue 9, Pages 813-814 ) DOI: 10.1016/S1470-2045(10)70185-6

Three clinical trials funded and started under the guise of such personalized medicine have been suspended, and the trials and associated methodology are now being reviewed by the National Academy of Sciences Institute of Medicine.

http://dukechronicle.com/print/153336

The Chronicle News » Health & Science IOM to review Potti research, clinical trials By Sonia Havele October 21, 2010



142.103.207.10 (talk) 02:31, 26 October 2010 (UTC)

Update: Dec 1, 2010

Anil Potti has resigned his position at Duke.

Collaborator Joseph Nevins has started proceedings to retract the paper

  1. Potti et al. (2006), Genomic Signatures to Guide the Use of Chemotherapeutics, Nature Medicine 12: 1294.


The paper (Potti as last author)

  1. Hsu et al. (2007), Pharmacogenomic Strategies Provide a Rational Approach to the Treatment of Cisplatin-Resistant Patients With Advanced Cancer, JCO Vol 25 No. 28 Oct 1, 2007

is now marked "This article was retracted on November 16, 2010".


There is a common thread in the style of statistical analysis performed in all the "personalized medicine" papers issuing from this group. First, all of the available data is pooled together, and some analysis performed on the entire set of data. This is typically a singular value decomposition, a factor analysis or something similar, and yields a handful of predictor variables. These were called "supergenes" or "metagenes" in earlier papers from this group. Then the data is split into subgroups, with further model building performed on one of the subgroups, including use of the predictors developed on the entire data set. The authors then show that the models developed on one of the subgroups continues to perform well on the other subgroups. These "validation" analyses have been called cross-validation, or split-sample training-validation analyses. From a statistical point of view, these exercises are not true cross-validation exercises, because they always use predictors developed initially on the entire data set. Really what the group is doing is overfitting a model to the entire data set, then showing that the model works well on subsets of the data. This is a known statistical phenomenon, which is why techniques such as cross-validation or split-sample evaluation were devised in the first place. Many of the papers from this group will have to be re-examined going forward, as the excessive claims of accuracy are based on overfitted models to the entire data set. Indeed when Baggerly and Coombes ran the Duke group's software on half of the data in the paper cited above (and related papers) and then truly ran a validation exercise on the other half of the data, the model's predictive ability was severely reduced relative to the claims made by the Duke group. —Preceding unsigned comment added by 142.103.207.10 (talk) 02:25, 2 December 2010 (UTC)

This article is antiquated[edit]

Are you writing the history of personalized medicine and comparing it with "aristotle"? It seems that there is nothing new about personalized medicine. You are not including the new publications that talks about let us say the importance of environment to personalized medicine (2010) and other new findings. What are you talking here are the 2001 publication , the 2007 alternative name.. what is this? I think only .00001% of the editors here know what PM is all about. Browse Medical News Today and look for the current references.... —Preceding unsigned comment added by 69.22.174.172 (talk) 16:46, 29 April 2011 (UTC)

A comment on stratified medicine[edit]

It is impossible to group people having singular/common need for one treatment(in this case breast cancer for a common blah blah) because they have other genes that may interact unfavorably/ differently to this similar treatment. Even applying SM to siblings/or to a family because their genes are more or less having a high percentage of similarities I can still see that SM will fail because even in families as well as among siblings there are genes/ epigenes that will not allow a similar cure of having a similar intensity (of curing) with that of the other siblings-- in other words there is still the difference-- so I would suggest not to use SM or BlockM - for each one needs a PM type of cure- an individualized medical care not a group care like SM or BM... these 2 are impossible and are even deviating from PM... misleading PM —Preceding unsigned comment added by 69.22.174.172 (talk) 17:11, 29 April 2011 (UTC)

External promotional links are not appropriate sources[edit]

To the editor(s?) using IP addresses 72.66.223.40, 72.66.199.136, and 128.173.102.238: Please provide adequate sources for your edits of 11/2011. Your initial additions were sourced entirely using external links to an entity promoting certain aspects of personalized medicine. These could be considered biased contributions aimed primarily at increasing web traffic, which is not an appropriate use for Wikipedia. Please see our guidelines on external links and reliable sources. Also, if you have any direct affiliation with the organization to whom you are providing external links (as I suspect due to one of your IP address mapping to the Virginia Polytechnic Institute, which coincidentally is the location of the organization to which you are linking), this could be considered a conflict of interest. --- Medical geneticist (talk) 00:37, 18 November 2011 (UTC)

Useful references for anyone working on this[edit]

Hi,

I'm coming across quite a few relevant things during my work on Molecular diagnostics. The two overlap in that all the real world examples of PM are either tests or therapies; and all the tests are also examples of Molecular diagnostics. So more cross-linking?

I've come across some general articles on PM, should they be of use:

This article is a useful primer, and reaction to the first ten years of full genome sequencing:

The Path to Personalized Medicine, 2010

Cheers,

Ian McDonald (talk) 19:16, 18 October 2013 (UTC)

new content about "expsome" etc[edit]

Creators of the exposome article and some related pages have added the following, which I deleted with the stated reason "revet addition that promotes one lab's publications. exposome is currently not medicine, but rather a research paradigm. is not "background"" The original poster restored it without an edit note. I reverted and re-deleted, citing WP:BRD, and just now User:So26 undeleted, again without an edit note. Not good wikipedia communication. Since the OP refused to start a discussion, I am doing it. Here is the new content.

Beyond germline genetics, molecular pathology is a much wider open area for therapeutic and preventive applications. Inter-personal difference of molecular pathology is diverse, so as inter-personal difference in the exposome, which influence disease processes through the interactome within the tissue microenvironment, differentially from person to person. As the theoretical basis of personalized medicine, the "unique disease principle"(ref)Ogino S, Lochhead P, Chan AT, Nishihara R, Cho E, Wolpin BM, Meyerhardt AJ, Meissner A, Schernhammer ES, Fuchs CS, Giovannucci E. Molecular pathological epidemiology of epigenetics: emerging integrative science to analyze environment, host, and disease. Mod Pathol 2013;26:465-484.(ref/) (which was first described in neoplastic diseases as the unique tumor principle(ref)Ogino S, Fuchs CS, Giovannucci E. How many molecular subtypes? Implications of the unique tumor principle in personalized medicine. Expert Rev Mol Diagn 2012; 12: 621-628.(ref/)) emerged to embrace the ubiquitous phenomenon of heterogeneity of disease etiology and pathogenesis. As the exposome is a common concept of epidemiology, personalized medicine is intertwined with molecular pathological epidemiology (MPE). MPE research is capable of identifying potential biomarkers for personalized precision medicine.(ref)Ogino S, Lochhead P, Giovannucci E, Meyerhardt JA, Fuchs CS, Chan AT. Discovery of colorectal cancer PIK3CA mutation as potential predictive biomarker: power and promise of molecular pathological epidemiology. Oncogene advance online publication 24 June 2013; doi: 10.1038/onc.2013.244(/ref)

This is pretty clear self-promotion by Ogino et al. Also it is not "background" for personalized medicine. The paradigm described above is an emerging one; pioneers in the field are building the basic science and infrastructure. If anything it is "forward looking research" or the like. but mostly, the fact that all the papers cited are from one group calls into question whether this is really notable enough for inclusion at all. if it stays it needs to be copyedited for better english and the claims toned down (it is not the theoretical basis for personalized medicine) and the over-wikilinking cut down. Jytdog (talk) 15:20, 17 February 2014 (UTC)


To address the above comment, a modification will be done in a neutral way so that you agree. — Preceding unsigned comment added by So26 (talkcontribs) 15:58, 17 February 2014 (UTC)