美国精准医学政策走向与反思

The Trends and Reflections from the Development of Precision Medicine Initiative in the United States

精准医学究竟是有待研究的假说?还是可以用来为人类治疗疾病和增进福祉的创新范式?美国相关论辩延续了奥巴马和特朗普两位总统的施政。首先回顾精准医学的核心价值在于实现个性化的疾病预防、诊断、预测和治疗。而后藉由《21世纪治愈法案》的立法过程呈现奥巴马方案的妥协和挫折,并以晚近美国研究范式发展的脉络来说明"全民健康研究项目"取代"精准医学先导队列项目"的意义,也说明特朗普大幅删减科研预算对精准医学发展的影响。总结精准医学将个性化取径保障病人主体地位成为可能,建议以物联网所蕴含的支持性临床场域的营造来实现此愿景。

Is the precision medicine a hypothesis yet to be verified?Or,could it be a new innovative paradigm for curing diseases and enriching wellbeing for humankind?There are major ongoing debates through the Obama's and Trump's administrations in the US.This paper begins with reviewing the core values of precision medicine in fulfilling personalized preventive,diagnostic,prognostic and therapeutic accounts on diseases.Then,the legislation process of the 21 st Century Cures Act is illustrated showing the compromises and frustrations related to Obama's original ideas.Within the contexts of American research paradigm shifts,this paper explains the meanings of name change from "The Precision Medicine Initiative(PMI)Cohort Program"to "The All of Us Research Program".Along the line,the influences of Trump's significant budget cut on scientific research are explored.We conclude that precision medicine will lead the possibilities of ensuring patient's autonomous subjectivity through personalized approaches and suggest that the development of supportive clinical settings through Internet of Things(IoT)will help us to reach the goals.