Abstract
Systems medicine is the culmination of the progression of the health/disease dichotomy to a continuum from health to disease allowing for measures of disease accumulation that mark an individual’s position, i.e., her wellness, along the continuum. Proponents of systems medicine have promised a scientific (non-normative), value-free, holistic measure of “wellness” that will be the cornerstone of P4 (personalized, predictive, preventive and participatory) medicine. While the focus of this paper is on the quantification of wellness, the authors also consider how this metric drives the rest of the P4 program. The authors trace the history of this development in order to appreciate the promises, problems, pitfalls, and perils that accompany this approach. To the 4Ps already in place, the authors add P5 = promissory and P6 = profitable, and find that the road to P6 medicine is paved with neoliberal theories.
Highlights
Kowalski and Mrdjenovich advised against indiscriminate dichotomization [1]
Since the primary interest is in the quantification of wellness, this discussion focuses on those definitions of health/disease that envision the two as extreme points on a continuous scale that will admit of at least the ability to order values along it
The authors focus on those “solutions” admitting of at least an ordinal scale connecting the endpoints, beginning with measures that lead to step-function progressions between health and disease
Summary
Kowalski and Mrdjenovich advised against indiscriminate dichotomization [1]. They looked at (i) nature vs nurture, and reductionism vs holism, and (ii) several of the ways the scientific pie can be sliced in two pieces, basic vs applied, physical science vs social science, etc., arguing that, in (i), focusing on one or the other of two dichotomous choices often deflects attention from a more fertile intermediate ground where more useful answers might be found, and that, in (ii), a more useful classification scheme than the basic/applied opposition would be based on the nature of the question being asked and the manner in which an answer is sought [2]. The authors focus on those “solutions” admitting of at least an ordinal scale connecting the endpoints, beginning with measures that lead to step-function progressions between health and disease. The step in this progression is the quantification of wellness, developed for use in P4 medicine, the clinical face of systems medicine, which is itself an offshoot of systems biology. This metric is to be scientific, yet useful in developing individualized treatment plans, and holistic, an all-encompassing summary of what it means to be well
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