什么是个性化医学:基于系统文献回顾来明晰一个模糊的术语。
What is personalized medicine: sharpening a vague term based on a systematic literature review.
机构信息
Ludwig-Maximilians-University Munich, Institute of Ethics, History and Theory of Medicine, Munich, Germany.
出版信息
BMC Med Ethics. 2013 Dec 21;14:55. doi: 10.1186/1472-6939-14-55.
BACKGROUND
Recently, individualized or personalized medicine (PM) has become a buzz word in the academic as well as public debate surrounding health care. However, PM lacks a clear definition and is open to interpretation. This conceptual vagueness complicates public discourse on chances, risks and limits of PM. Furthermore, stakeholders might use it to further their respective interests and preferences. For these reasons it is important to have a shared understanding of PM. In this paper, we present a sufficiently precise as well as adequate definition of PM with the potential of wide acceptance.
METHODS
For this purpose, in a first step a systematic literature review was conducted to understand how PM is actually used in scientific practice. PubMed was searched using the keywords "individualized medicine", "individualised medicine", "personalized medicine" and "personalised medicine" connected by the Boolean operator OR. A data extraction tabloid was developed putting forward a means/ends-division. Full-texts of articles containing the search terms in title or abstract were screened for definitions. Definitions were extracted; according to the means/ends distinction their elements were assigned to the corresponding category. To reduce complexity of the resulting list, summary categories were developed inductively from the data using thematic analysis. In a second step, six well-known criteria for adequate definitions were applied to these categories to derive a so-called precising definition.
RESULTS
We identified 2457 articles containing the terms PM in title or abstract. Of those 683 contained a definition of PM and were thus included in our review. 1459 ends and 1025 means were found in the definitions. From these we derived the precising definition: PM seeks to improve stratification and timing of health care by utilizing biological information and biomarkers on the level of molecular disease pathways, genetics, proteomics as well as metabolomics.
CONCLUSIONS
Our definition includes the aspects that are specific for developments labeled as PM while, on the other hand, recognizing the limits of these developments. Furthermore, it is supported by the quantitative analysis of PM definitions in the literature, which suggests that it it is widely acceptable and thus has the potential to avoid the above mentioned issues.
背景
最近,个体化或个性化医学(PM)在学术和公共医疗保健辩论中成为一个热门词汇。然而,PM 缺乏明确的定义,容易产生不同的解释。这种概念上的模糊性使人们难以讨论 PM 的机会、风险和局限性。此外,利益相关者可能会利用它来推进各自的利益和偏好。出于这些原因,对 PM 有一个共同的理解是很重要的。在本文中,我们提出了一个足够精确和充分的 PM 定义,具有广泛接受的潜力。
方法
为此,我们首先进行了系统的文献回顾,以了解 PM 在科学实践中是如何实际使用的。使用关键词“个体化医学”、“个体化医学”、“个性化医学”和“个性化医学”在 PubMed 中进行搜索,并用布尔运算符“OR”连接。开发了一个数据提取模板,提出了一种手段/目的划分。对包含标题或摘要中搜索词的文章全文进行筛选,以获取定义。提取定义;根据手段/目的的区别,将其元素分配到相应的类别。为了简化复杂的列表,从数据中使用主题分析归纳出总结类别。在第二步中,我们应用了六个充分定义的标准来对这些类别进行分析,得出一个所谓的精确定义。
结果
我们确定了 2457 篇包含标题或摘要中 PM 术语的文章。其中 683 篇包含 PM 的定义,因此被纳入我们的综述。在这些定义中发现了 1459 个目的和 1025 个手段。从这些定义中我们得出了精确的定义:PM 通过利用分子疾病途径、遗传学、蛋白质组学和代谢组学水平上的生物信息和生物标志物,旨在改善医疗保健的分层和时机。
结论
我们的定义包括了被标记为 PM 的发展所特有的方面,同时,另一方面,也认识到这些发展的局限性。此外,它还得到了文献中 PM 定义的定量分析的支持,这表明它具有广泛的可接受性,因此有可能避免上述问题。