{"id":7846,"date":"2011-04-21T12:19:26","date_gmt":"2011-04-21T16:19:26","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=7846"},"modified":"2011-04-22T18:52:38","modified_gmt":"2011-04-22T22:52:38","slug":"personalized-medicine-a-preventive-medicine-polemic","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2011\/04\/21\/personalized-medicine-a-preventive-medicine-polemic\/","title":{"rendered":"personalized medicine: a preventive medicine polemic…"},"content":{"rendered":"
Depression will be the second leading contributor to the burden of disease by 2020. There is therefore an urgent need to identify objective indicators of risk for depression, and to understand their link to underlying biological mechanisms and treatment. To date, candidate risk markers such as genetic polymorphisms, vulnerability to stress, personality traits, and alterations in brain function, structure and cognition have tended to be assessed in separate studies. The integrative relationships between these factors, and how they may interact to predict depression and anxiety, remain unknown…<\/font><\/em><\/sup>ref<\/strong><\/a><\/sub><\/div>\n

In my last post, I talked about some of the emergent paradigms in the modern medical scene – evidence-based medicine<\/font><\/strong>, translational medicine<\/font><\/strong>, and personalized medicine<\/font><\/strong>. It was kind of boring, but I don’t know what I think until I say some things, then I figure out what I wanted to say but hadn’t quite formulated. What I really wanted to talk about was a much older medical paradigm that trumps these new pretenders to the throne – preventive medicine<\/font><\/strong>.<\/p>\n

Descriptions of the development of medicine usually go like this: Doctors began by focusing on treating the illnesses that were solidly in place, trying to relieve suffering and prevent deterioration [now called tertiary prevention<\/em><\/strong>]. Then they figured out that if you could get there before the disease was firmly entrenched, you had a better shot [so Crawford Long took out the appendix before it ruptured, women get mammograms to find the earliest sign of breast cancer][now called early detection – secondary prevention<\/em><\/strong>]. Then doctors figured out an even better idea. If possible, prevent the disease altogether [don’t smoke, don’t use asbestos, get immunizations, kill mosquitoes, etc][that’s called primary prevention<\/em><\/strong>].<\/p>\n

But that story leaves out the oldest medical principle of all, primum non nocere<\/em><\/font><\/strong> [first, do no harm]. It’s paradoxically called quaternary prevention<\/em><\/strong> – which seems odd. Shouldn’t it come first? Whatever. Here’s the official lexicon for preventive medicine: <\/p>\n\n\n\n\n\n\n\n
PREVENTIVE MEDICINE<\/font><\/strong><\/p>\n
<\/td>\n<\/tr>\n
Level<\/strong><\/td>\nDefinition<\/strong><\/td>\n<\/tr>\n
Primary prevention<\/td>\nPrimary prevention strategies intend to avoid the development of disease. Most population-based health promotion activities are primary preventive measures.<\/td>\n<\/tr>\n
Secondary prevention<\/td>\nSecondary prevention strategies attempt to diagnose and treat an existing disease in its early stages before it results in significant morbidity.<\/td>\n<\/tr>\n
Tertiary prevention<\/td>\nThese treatments aim to reduce the negative impact of established disease by restoring function and reducing disease-related complications.<\/td>\n<\/tr>\n
Quaternary prevention<\/td>\nThis term describes the set of health activities that mitigate or avoid the consequences of unnecessary or excessive interventions in the health system.<\/font><\/strong><\/td>\n<\/tr>\n<\/table>\n

<\/p>\n

When I read the psychiatric literature about personalized medicine, I find two themes:<\/div>\n