Jerald P. Radich, MD, Director of the Molecular Oncology Lab at the Fred Hutchinson Cancer Research Center, and Professor of Medicine at the University of Washington School of Medicine, Seattle, Washington.
Q: What’s in a name? Should “it” be “Personalized Medicine,” “Precision Medicine,” or perhaps, “Accurate Medicine”?
A: Much of what we do in my laboratory at the Fred Hutchinson Cancer Research Center revolves around the genetics of response and relapse in leukemia. I often describe this as the biology of luck. Why do some good risk patients fail to respond to therapy, while some patients with characteristics of very poor risk nevertheless respond well? This phenomenon is often ascribed to deity, diet, or luck.
One must hope that there is some biology behind the differential response we see in patients. This then is the heart of “personalized” or “precision” medicine. Words matter, however, and in this case, neither of these trendy phrases passes muster. The term “personalized medicine” suggests that prior to the current revolutionary approach, we did not consider our patients to be unique. This is both wrong and insulting. I cannot remember a time where personal features like age, physical condition, comorbidities, and social elements were not as much a part of treatment considerations as were leukemia cell type and cytogenetic findings. A quote ascribed to both Hippocrates (400 BCE) and/or Caleb Parry (18th century) says it well: “It is much more important to know what kind of patient has a disease than to know what kind of disease a patient has.”
”Precision medicine” is a misnomer. If you imagine a target, precision means how tightly the arrows are clustered, whereas accuracy describes the proximity of the arrows to the bull’s eye. Therefore, you could have a very precise diagnostic assay but not be anywhere near the target (truth).
Thus a byline slogan for precision medicine could be “We’re reproducible wrong!” Famed British economist John Maynard Keynes once keenly observed, “I’d rather be vaguely right than precisely wrong.” Other terms that might be considered for this field of contemporary medicine and that are improvements include “accurate medicine” (though admittedly, that doesn’t sound very snappy), “bespoke medicine” (imagine a stylish and perfectly tailored suit), or perhaps simply modernmedicine or good medicine.
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