Personalized Medicine - Translational Informatics: Realizing the Promise of Knowledge-Driven Healthcare - page 38

Together, these various omic technologies have provided biomedical researchers,
and increasingly health care providers, with new instruments with which to query
the state of an individual. In much the same way as the microscope and stethoscope
changed the way doctors surveyed the conditions of their patients, so too has the
omic era expanded the scope of possible clinical observations, enabling a much
more fi ne-grained picture of what is going on with a patient.

3.3 Medicine by Any Other Name

Between the medical literature, a major report from the Institute of Medicine, and
mainstream media, personalized medicine has been extolled as the future of health
care. In this section we discuss what is meant by personalized medicine, as well as
some issues and caveats around it.

3.3.1 P*

While there is near consensus regarding the need for personalized medicine, far less
agreed upon is what to call it. A 2011 report by the Institute of Medicine describes
a path toward “Precision Medicine” [ 7 ]. Others refer to P4 medicine (predictive,
preventive, personalized, participatory) [ 8 ], individualized [ 9 ], targeted [ 10 ],
genomic [ 11 ], or stratifi ed medicine [ 12 ]. The details or emphasis for each of these
concepts varies, e.g. a focus on genes and gene products, timely intervention, patient
proactivity, or grouping individuals into similar cohorts, but common across all of
these concepts is improving our ability to target the right intervention for the right
patient at the right time (See Fig. 3.4 .).

3.3.2 Biomarkers

Biomarkers may be defi ned as any biological phenomenon that gives informa-
tion regarding some underlying biological state [ 14 ]. Macroscopic biomarkers
have been used for millennia—fever, pain, rash. More recently, in the latter half
of the twentieth century, cellular and molecular data points, e.g., glucose, antibod-
ies, and prostate specifi c antigen (PSA), have been used in this way. The various
omics technologies described above have opened up a new frontier of potential
biomarkers. Often these biomarkers represent not a single data point but a multi-
dimensional signature of biomarkers. These signatures may be used to further
stratify individuals, beyond the limited diagnosis or prognosis enabled by more
traditional methods.