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Patient Similarity in the Era of Precision Medicine: A Philosophical Analysis

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Abstract

According to N. Goodman, the Carnapian notion of similarity is useless in science and without interest for philosophy. In our paper we suggest that, given the current role that the notion of similarity has in managing biomedical big data, this drastic position should be revised, and similarity should be provided a scientifically useful philosophical interpretation. With the advent of the new sequencing technologies, imaging technologies and with the improvements of health records, the number of genomics, post-genomics and clinical data has exponentially increased. The deluge of data has urged, among others, to devise a new way of stratifying patients. A solution has been found and it is based exactly on the notion of similarity. By discussing two examples focusing on similarity among breast cancer patients, in the paper we illustrate such a use, and analyze it from a philosophical standpoint by resorting to A. Tversky’s features matching approach. We believe that the latter can foster some better understanding of the meaning and current use of similarity in the context of biomedical big data, and that, therefore, be the focus of further reflections in the philosophy of science, in particular in the philosophy of biomedicine.

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Notes

  1. It is worth recalling that the similarity notion based on the metric came out in geometry around 1906, thanks to the work of the French mathematicians René Fréchet (even if the name is due to Felix Hausdorff) when he discussed the notion of distance between two points of a topological space. Carnap’s work was very close to the dawn of the mathematical birth of that notion.

  2. We do not discuss here the limits and the potentialities of precision medicine, in particular if precision medicine is really precise or if it is always ethically praiseworthy (both at individual and global level). We do not even face the question whether a more proper definition of precision medicine exists, or which its historical roots are. This is not the right place to face these issues. For our sake, however, we pragmatically accept the well-known definition offered by the US National Research Council, according to which “precision medicine is ‘an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person’, [meant] […] to predict more accurately which treatment and prevention strategies for a particular disease will work in which groups of people”: https://ghr.nlm.nih.gov/ Precision Medicine; on the relations between precision and personalized medicine, https://ghr.nlm.nih.gov/primer/precisionmedicine/precisionvspersonalized. See also https://www.nih.gov/research-training/allofus-research-program (Accessed 30 April 2017). See Barilan, Brusa and Ciechanover 2021.

  3. PAM50 Prosigna® is a tumour-profiling test that helps determine the benefit of using chemotherapy in addition to hormone therapy for some estrogen receptor-positive (ER-positive) and HER2-negative breast cancers.

  4. A tumour is said to have had a pCR if, after surgery, no residual cancer cells remain.

  5. For a more technical approach, see Zhu et al. (2016).

  6. This is also the reason why here the distance can be negative, while one of the conditions in the original metric space introduced in geometry and discussed by Carnap was that it has to be positive: a statistical space realized with biomedical data is different from an abstract topological space endowed with a metric.

  7. Due to space limits, we do not show here that also the independence conditions is satisfied.

  8. For other philosophical applications of the FMA, and, specifically, on using similarity for vagueness and identity, see Douven and Decock (2011).

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Acknowledgements

We wish to thank the referees of Erkenntnis for their comments and suggestions on preliminary versions of the paper.

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Authors and Affiliations

  1. Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara, 64a, 44121, Ferrara, Italy

    Giovanni Boniolo

  2. Departments of Philosophy and Communication Studies, University of Bologna, Via Zamboni, 38, 40126, Bologna, Italy

    Raffaella Campaner

  3. FISPPA Department, University of Padua, P. zza Capitaniato 3, 35139, Padova, Italy

    Massimiliano Carrara

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  1. Giovanni Boniolo
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  2. Raffaella Campaner
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  3. Massimiliano Carrara
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Correspondence to Massimiliano Carrara.

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Boniolo, G., Campaner, R. & Carrara, M. Patient Similarity in the Era of Precision Medicine: A Philosophical Analysis. Erkenn 88, 2911–2932 (2023). https://doi.org/10.1007/s10670-021-00483-w

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