Types of Evidence for Personalised Medicine?

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Generally speaking, pinpointing logical fallacies in argumentation is one of the most distinctive features of philosophical activity. Recently, the inappropriate use of evidence to support bold claims published in top-notch scientific journals has struck me.

For instance, a recent conference at the University of Oxford discussed the Promise, Hype and Pitfalls of personalised medicine. In a recent outlook of Nature, V. Prasad harshly criticised personalised oncology, namely the idea that we can effectively treat tumours by exploiting their genetic information, linking patients to the best drugs according to tumour mutations. While, in a recent Jama’s Viewpoint MJ. Joyner et al. openly criticised personalised medicine, allegedly considered as an overfunded yet underperforming venture. Both authors warrant their claims mostly on the basis of the limited success of few clinical trials, such as the NCI-MATCH, without considering the possibility that those failures might be due to shortcomings in trial methodology.

Indeed, from a theoretical standpoint, genomics offers an actionable entry into virtually all diseases with a genetic basis: it is still the best set of ideas to understand the underlying biology of morbidities.  It is only been 10 years since the release of the complete sequence of the human genome and from major breakthroughs in stem cell research, such as cell reprogramming. Yet, we have already achieved some major advancements in gene and stem cell therapy. With the former we can treat rare and less rare diseases, such as Wiskott-Aldrich syndrome and hemophilia B, while stem cell therapy is now a commercial reality for corneal regeneration.

However, cherry-picking evidence is not the best way to seriously evaluate the contribution of personalised medicine to health care improvement. We need a better critical appraisal of all the available evidence, assessing its relevance and synthesizing it to create a coherent picture that would serve as a benchmark of our expectations. Blaming or praising personalised medicine because of some failures or successes is nether interesting nor useful for improving medical decisions and patient outcomes.

words by Mattia Andreoletti

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