Personalized medicine: evidence of normativity in its quantitative definition of health.

Henrik Vogt,Linn Getz,Bjørn Hofmann

doi:10.1007/s11017-016-9379-3

Abstract

Systems medicine, which is based on computational modelling of biological systems, is emerging as an increasingly prominent part of the personalized medicine movement. It is often promoted as ‘P4 medicine’ (predictive, preventive, personalized, and participatory). In this article, we test promises made by some of its proponents that systems medicine will be able to develop a scientific, quantitative metric for wellness that will eliminate the purported vagueness, ambiguity, and incompleteness—that is, normativity—of previous health definitions. We do so by examining the most concrete and relevant evidence for such a metric available: a patent that describes a systems medicine method for assessing health and disease. We find that although systems medicine is promoted as heralding an era of transformative scientific objectivity, its definition of health seems at present still normatively based. As such, we argue that it will be open to influence from various stakeholders and that its purported objectivity may conceal important scientific, philosophical, and political issues. We also argue that this is an example of a general trend within biomedicine to create overly hopeful visions and expectations for the future.

Highlights

The emerging concept of systems medicine has become an increasingly prominent part of the movement towards personalized medicine in the wake of the sequencing of the human genome 15 years ago [1]
We find that systems medicine is promoted as heralding an era of transformative scientific objectivity, its definition of health seems at present still normatively based
By examining in particular a US patent assigned to the Institute for Systems Biology (ISB) that describes a method for assessing health and disease [19], and referring to concrete examples of ISBs work with diagnoses, we argue that systems medicine has so far not provided a non-normative way of defining health

Summary

Introduction

The emerging concept of systems medicine has become an increasingly prominent part of the movement towards personalized (or precision) medicine in the wake of the sequencing of the human genome 15 years ago [1]. By examining in particular a US patent assigned to the ISB that describes a method for assessing health and disease [19], and referring to concrete examples of ISBs work with diagnoses, we argue that systems medicine has so far not provided a non-normative way of defining health. The patent in question refers to the concept of a ‘health-associated reference expression region’, which reflects health, and how such a region can be determined We find this to be the most concrete and relevant description to date of how health or wellness will be defined in P4 systems medicine, and to be the closest thing yet to a metric for wellness found in the literature. One skilled in the art can readily determine whether an individual has signs or symptoms that are recognizable as lying outside the condition of a healthy individual’ [19, p. 16] (emphasis added)

Discussion

Conclusion