The Ethics of Personalised Medicine

In this context, personalised medicine (PM) is understood as the application of biological data to improve the diagnosis, therapy and prevention of diseases. It has become a symbol of medical progress and better healthcare, but has given rise to controversial debate in relation to its promises. In the last issue (p. 62) I reviewed a book on the decision trap created by an overly deterministic and statistical approach to the subject where patients become gene and risk carriers. Three main understandings of the term are cited: PM is not new because medicine has always been individualised; it is in fact holistic healthcare, as many readers might suppose; and it is treatment targeted at stratified subgroups using various genetic and molecular biomarkers. Apart from Chapter 6, most of the discussion is focused on the third view. Various sections explore concepts and contextual aspects, clinical research with a focus on oncology, personalised medicine and healthcare systems and some recommendations in the oncological field. My impression is that the third view is more accurately called stratified medicine, although personalised or individualised medicine is rhetorically more attractive. Much of the discussion is at a specialist in technical level, and the authors conclude that targeted treatment is realistic for only a minority of patients going to multiple genetic variations and the interplay between environmental and genetic factors.