个体化医疗：一种新医疗范式的承诺、问题和危险

Personalized Medicine: Promises,Problems and Perils of a New Paradigm for Healthcare

医疗服务的一种新范式正以"个体化医疗"的名义逐渐显现。支持者宣称,运用遗传学手段明确机体特性并为个体制订相应的疗法,已使针对个体特性制订医疗计划成为可能。他们还认为医学的重点将由治疗前移到预防。据称,遗传学近期研究成果的遗传检测技术,可以使医生在病人出现先兆前获知某些常见疾病易感性的情况,并在此基础上制定预防计划、减少个人和社会的疾病负担。此外,遗传信息将为药物和药物用量大小的选择提供依据,避免药物副作用、减少浪费、降低成本、提高效率。与其他科学进步一道,医学的未来被认为应当且将成为"个体化的、可预测的和可预防的"。利用这些进展,日益增多的个体化遗传检测公司"直接向消费者"推销服务,宣称可以检测个体疾病易感性,而这些信息可以赋予消费者个体责任及管理自身健康的能力。本文批判性地评估了个体化医疗做出的承诺,讨论了卫生政策面临的一些挑战,并关注了将医疗向个体化和个性化方向推进对社会和道德产生的影响。

A new paradigm for medical care is emerging which terms itself ＂ personalized medicine＂. Advocates claim that medical treatment can now be targeted on the specific characteristics of each individual, using genetic profiling to identify the particular nature of the condition, and to tailor treatments for each person. Further, they argue, the focus of medicine will move from treatment to prevention. It is claimed that genetic tests based on recent genomic research will enable doctors to identify susceptibilities for such common conditions before the onset of illness, and to target preventive intervention to reduce the individual and social burdens of ill health. Further, it is argued that genetic information will allow precision in the choice of drugs and doses, avoiding adverse reactions, minimizing waste, reducing costs and increasing efficacy. Coupled with other advances, it is argued that the future of medicine should and will be ＂ personalized, predictive and preventive＂. Drawing on such developments, we have seen the growth of personal genomics companies marketing tests ＂ direct to consumers＂ that claim to identify individual disease susceptibilities and to ＂empower＂ individuals by giving them the information--and the personal responsibility -- to manage their own health. This paper critically assesses the promises made for personalized medicine, discusses some of the challenges for health policy, and considers the social and ethical implications for of moving medical care towards such a personalized and individualized model.