Predictive, preventive, personalized and participatory medicine (4P): narrative review

Abstract

4 P medicine is a concept used in healthcare and biomedical research that is based on the principles of prediction, personalization, prevention, and participation. It is increasingly used which has enabled the rapid development of medicine: several forms/types of pathologies have been discovered, for which specific treatments and appropriate prevention strategies have been developed, it has become possible to predict the evolution of health and disease, all these would be useless without the participation of the patient, family, and decision makers.The purpose of this article is to provide an overview of the 4 P medicine and its preventive, predictive, personalized, and participatory principles through the lens of clinical practice.Materials and Methods: The database was searched for the keywords “4P medicine”, “personalized medicine”, “participatory medicine”, “systems medicine”. For the term “systems medicine” we obtained 5,257,904 results, in the last 10 years - there were 2,396,921 publications, journal articles - 2.4 million citations, book chapters - 11 thousand, related to medicine - 1.6 million of the references. For the term “precision medicine” 158,239 references appeared, for “personalized medicine” - 91,883 citations and for “participatory medicine” - 17,579 references. Most references were published in English. For the search for “personalized medicine oncology” - 18,209 references appeared, for “personalized medicine neurology” 4,751 references were discovered, in the last 10 years 4,336 of them were published, being journal articles4,300 and 16 book chapters. Most publications talk about the use of the principles of personalized medicine (4P) in demyelinating pathologies, epilepsy, dementia, neuro-oncology, stroke, migraine, neuroimaging, and neurorehabilitation. Results and discussions: 4P medicine is at the intersection of three major trends: the growing ability of systems biology and medicine to decipher the biological complexity of pathologies, the digital revolution that has increased theability to collect, integrate, store, analyze and communicate data and information, and consumer access to information.Conclusion: 4P medicine is a concept used in biomedical research and human health care that was taken from systems biology and systems medicine. It is a form of approach that uses the principles of prevention, prediction, personalization, and participation to transform healthcare from a reactive to a proactive one. The use of the principles of 4P medicine in clinical practice allows the deciphering of forms of the disease, the stratification according to pathophysiological mechanisms, the application of personalized treatment to the patient, respectively more efficiently and with fewer adverse reactions.