The prospects of precision psychiatry.

Abstract

Since the turn of the twenty-first century, biomedical psychiatry around the globe has embraced the so-called precision medicine paradigm, a model for medical research that uses innovative techniques fordata collection and analysis to reevaluate traditional theories of disease. The goal of precision medicineis to improve diagnostics by restratifying the patient population on the basis of a deeper understandingof disease processes. This paper argues that precision is ill-fitting for psychiatry for two reasons. First, in psychiatry,unlike in fields like oncology, precision medicine has been understood as an attempt to improve medicine bycasting out, rather than merely revising, traditional taxonomic tools. Second, in psychiatry the term "biomarker" is often used in reference to signs or symptoms thatallow patients to be classified and then matched with treatments; however, in oncology"biomarker" usually refers to a disease mechanism that is useful not only for diagnostics, but alsofor discovering causal pathways that drug therapies can target. Given these differences between how the precision medicine paradigm operates inpsychiatry and in other medical fields like oncology, while precision psychiatry may offer successfulrhetoric, it is not a promising paradigm.