Delpierre Cyrille, Lefèvre Thomas
Centre for Epidemiology and Research in POPulation Health (CERPOP) UMR1295, INSERM-Université Toulouse III, Toulouse, France.
Institut de Recherche Interdisciplinaire sur les Enjeux Sociaux (IRIS) CNRS UMR8156 INSERM U997 EHESS USPN, Paris, France.
Front Sociol. 2023 Feb 21;8:1112159. doi: 10.3389/fsoc.2023.1112159. eCollection 2023.
The US National Human Genome Research Institute defines precision medicine as follows: "Precision medicine (generally considered analogous to personalized medicine or individualized medicine) is an innovative approach that uses information about an individual's genomic, environmental, and lifestyle information to guide decisions related to their medical management. The goal of precision medicine is to provide a more precise approach for the prevention, diagnosis, and treatment of disease." In this perspective article, we question this definition of precision medicine and the risks linked to its current practice and development. We highlight that in practice, precision medicine is based on the use of large volumes of biological data for individual purposes mostly in line with the biomedical model of health, which carries the risk of the biological reductionism of the person. A more comprehensive, precise, and even "personal" approach to health would require taking into account environmental, socio-economic, psychological, and biological determinants, an approach more in line with the biopsychosocial model of health. The role of environmental exposures, in a broad sense, is highlighted more and more, notably in the field of exposome research. Not considering the conceptual framework in which precision medicine is deployed leads to the concealment of the different responsibilities that can be mobilized within the health system. Anchoring precision medicine in a model that does not limit its definition to its biological and technical components makes it possible to envisage a personalized and more precise medicine, integrating a greater share of interventions centered on the skills and life contexts of individuals.
“精准医学（通常被认为等同于个性化医学或个体化医学）是一种创新方法，它利用个体的基因组、环境和生活方式信息来指导与其医疗管理相关的决策。精准医学的目标是为疾病的预防、诊断和治疗提供一种更精确的方法。” 在这篇观点文章中，我们对精准医学的这一定义以及与其当前实践和发展相关的风险提出质疑。我们强调，在实践中，精准医学主要基于将大量生物数据用于个体目的，这大多符合生物医学健康模式，而这存在将人进行生物还原论的风险。一种更全面、精确甚至 “个性化” 的健康方法需要考虑环境、社会经济、心理和生物决定因素，这种方法更符合生物心理社会健康模式。从广义上讲，环境暴露的作用越来越受到重视，尤其是在暴露组研究领域。不考虑精准医学所应用的概念框架会导致掩盖卫生系统中可以调动的不同责任。将精准医学置于一个不将其定义局限于生物和技术成分的模式中，就有可能设想出一种个性化且更精确的医学，整合更多以个体技能和生活背景为中心的干预措施。
