Skip to main content

Personalised Medicine: A Critique on the Future of Health Care

Abstract

In recent years we have seen the emergence of “personalised medicine.” This development can be seen as the logical product of reductionism in medical science in which disease is increasingly understood in molecular terms. Personalised medicine has flourished as a consequence of the application of neoliberal principles to health care, whereby a commercial and social need for personalised medicine has been created. More specifically, personalised medicine benefits from the ongoing commercialisation of the body and of genetic knowledge, the idea that health is defined by genetics, and the emphasis the state places on individual citizens as being “responsible for” their own health. In this paper I critique the emergence of personalised medicine by examining the ways in which it has already impacted upon health and health care delivery.

This is a preview of subscription content, access via your institution.

References

  1. Aronowitz, R.A. 2004. When do symptoms become a disease? In Health, disease, and illness: Concepts in medicine, ed. A.L. Caplan, J.J. McCartney, and D.A. Sisti, 65–76. Washington: Georgetown University Press.

    Google Scholar 

  2. Baselga, J., L. Norton, J. Albanell, Y.M. Kim, and J. Mendelsohn. 1998. Recombinant humanized anti-HER2 antibody (Herceptin™) enhances the antitumor activity of paclitaxel and doxorubicin against HER2/neu overexpressing human breast cancer xenografts. Cancer Research 58(13): 2825–2831.

    PubMed  CAS  Google Scholar 

  3. Bentley, D.R. 2004. Genomes for medicine. Nature 429(6990): 440–445.

    PubMed  Article  CAS  Google Scholar 

  4. Boorse, C. 1975. On the distinction between disease and illness. Philosophy and Public Affairs 5(1): 49–68.

    Google Scholar 

  5. Boorse, C. 1977. Health as a theoretical concept. Philosophy of Science 44(4): 542–573.

    Article  Google Scholar 

  6. Burke, W., and B.M. Psaty. 2007. Personalized medicine in the era of genomics. Journal of the American Medical Association 298(14): 1682–1684.

    PubMed  Article  CAS  Google Scholar 

  7. Burke, W., H. Burton, A.E. Hall, et al. 2010. Extending the reach of public health genomics: What should be the agenda for public health in an era of genome-based and “personalized” medicine? Genetics in Medicine 12(12): 785–791.

    PubMed  Article  Google Scholar 

  8. Canguilhem, G. 1989. The normal and the pathological. New York: Zone Books. Originally published as Le normal et le pathologique (Paris: Les Presses Universitaires de France, 1966).

    Google Scholar 

  9. Canguilhem, G. 2004. The normal and the pathological—introduction to the problem. In Health, disease, and illness: Concepts in medicine, ed. A.L. Caplan, J.J. McCartney, and D.A. Sisti, 40–42. Washington: Georgetown University Press.

    Google Scholar 

  10. Caremark, Inc. 1998. Biotechnology breakthrough in breast cancer wins FDA approval. New Drug Review: Caremark New Drug Quick-Facts 1(11): 1.

    Google Scholar 

  11. Conti, R., D.L. Veenstra, K. Armstrong, L.J. Lesko, and S.D. Grosse. 2010. Personalized medicine and genomics: Challenges and opportunities in assessing effectiveness, cost-effectiveness, and future research priorities. Medical Decision Making 30(3): 328–340.

    PubMed  Article  Google Scholar 

  12. Evans, J., and M.J. Khoury. 2007. Evidence-based medicine meets genomic medicine. Genetics in Medicine 9(12): 799–800.

    PubMed  Article  Google Scholar 

  13. Fairclough, N. 1993. Critical discourse analysis and the marketization of public discourse: The universities. Discourse and Society 4(2): 133–168.

    Article  Google Scholar 

  14. Foucault, M. 1995. Discipline and punish: The birth of the prison, 2nd edition. Trans. A. Sheridan. New York: Random House. Originally published as Surveiller et punir: Naissance de la prison (Paris: Éditions Gallimard, 1975).

  15. Frank, A.W. 2000. All the things which do not fit: Baudrillard and medical consumerism. Families, Systems & Health 18(2): 205–216.

    Article  Google Scholar 

  16. Frank, A.W. 2002. What’s wrong with medical consumerism? In Consuming health: The commodification of health care, ed. S. Henderson and A. Petersen, 13–30. London: Routledge.

    Google Scholar 

  17. Frueh, F.W., and D. Gurwitz. 2004. From pharmacogenetics to personalized medicine: A vital need for educating health professionals and the community. Pharmacogenomics 5(5): 571–579.

    PubMed  Article  Google Scholar 

  18. Ginsburg, G.S., and J.J. McCarthy. 2001. Personalized medicine: Revolutionizing drug discovery and patient care. Trends in Biotechnology 19(12): 491–496.

    PubMed  Article  CAS  Google Scholar 

  19. Ginsburg, G.S., and H.F. Willard. 2009. Genomic and personalized medicine: Foundations and applications. Translational Research 154(6): 277–287.

    PubMed  Article  Google Scholar 

  20. Grace, V.M. 1991. The marketing of empowerment and the construction of the health consumer: A critique of health promotion. International Journal of Health Services 21(2): 329–343.

    PubMed  Article  CAS  Google Scholar 

  21. Grace, V.M. 1994. What is a health consumer? In Just health: Inequality in illness, care and prevention, ed. C. Waddell and A.R. Petersen, 271–283. Melbourne: Churchill Livingston.

    Google Scholar 

  22. Guttmacher, A.E., M.E. Porteous, and J.D. McInerney. 2007. Educating health-care professionals about genetics and genomics. Nature Reviews Genetics 8(2): 151–157.

    PubMed  Article  CAS  Google Scholar 

  23. Hallgrímsson, B., and B.K. Hall. 2011. Epigenetics: Linking genotype and phenotype in development and evolution. Berkeley: University of California Press.

    Google Scholar 

  24. Hamburg, M.A., and F.S. Collins. 2010. The path to personalized medicine. The New England Journal of Medicine 363(4): 301–304.

    PubMed  Article  CAS  Google Scholar 

  25. Hedgecoe, A. 2004. The politics of personalised medicine: Pharmacogenetics in the clinic. New York: Cambridge University Press.

    Book  Google Scholar 

  26. Hendersen, S., and A. Petersen. 2002. Consuming health: The commodification of health care. London: Routledge.

    Google Scholar 

  27. Hogg, C. 1999. Patients, power and politics: From patients to citizens. London: Sage.

    Google Scholar 

  28. Katsios, C., and D.H. Roukos. 2010. Individual genomes and personalized medicine: Life diversity and complexity. Personalized Medicine 7(4): 347–350.

    Article  CAS  Google Scholar 

  29. Khoury, M.J. 1996. From genes to public health: The applications of genetic technology in disease prevention. Genetics Working Group. American Journal of Public Health 86(12): 1717–1722.

    PubMed  Article  CAS  Google Scholar 

  30. Khoury, M.J. 2010. Dealing with the evidence dilemma in genomics and personalized medicine. Clinical Pharmacology and Therapeutics 87(6): 635–638.

    PubMed  Article  CAS  Google Scholar 

  31. Law, J. 2006. Big Pharma: How the world’s biggest drug companies control illness. London: Constable and Robinson Ltd.

    Google Scholar 

  32. Leiss, W. 1976. The limits to satisfaction: An essay on the problem of needs and commodities. Toronto: University of Toronto Press.

    Google Scholar 

  33. Lunshof, J.E. 2006. Personalized medicine: New perspectives–new ethics? Personalized Medicine 3(2): 187–194.

    Article  Google Scholar 

  34. Lupton, D. 1994. Consumerism, commodity culture and health promotion. Health Promotion International 9(2): 111–118.

    Article  Google Scholar 

  35. Meyer, J.M., and G.S. Ginsburg. 2002. The path to personalized medicine. Current Opinion in Chemical Biology 6(4): 434–438.

    PubMed  Article  CAS  Google Scholar 

  36. Miringoff, M.L. 1991. The social costs of genetic welfare. New Brunswick: Rutgers University Press.

    Google Scholar 

  37. Moynihan, R., and A. Cassels. 2005. Selling sickness: How drug companies are turning us all into patients. Crows Nest: Allen and Unwin.

    Google Scholar 

  38. NHMRC. 2011. Personalised medicine and genetics. National Health and Medical Research Council, July 4. http://www.nhmrc.gov.au/your-health/egenetics/personalised-medicine. Accessed December 21, 2011.

  39. Ormond, K.E., M.T. Wheeler, L. Hudgins, et al. 2010. Challenges in the clinical application of whole-genome sequencing. Lancet 375(9727): 1749–1751.

    PubMed  Article  Google Scholar 

  40. Petersen, A. 2006. The genetic conception of health: Is it as radical as claimed? Health 10(4): 481–500.

    PubMed  Google Scholar 

  41. Petersen, A. 2009. The ethics of expectations: Biobanks and the promise of personalised medicine. Monash Bioethics Review 28(1): 5.1–5.12.

    Google Scholar 

  42. Petersen, A., and R. Bunton. 2002. The new genetics and the public’s health. London: Routledge.

    Google Scholar 

  43. Petersen, A., and D. Lupton. 1996. The new public health: Health and self in the age of risk. St. Leonards: Allen and Unwin.

    Google Scholar 

  44. Phillips, K.A., D.L. Veenstra, S.D. Ramsey, S.L. Van Bebber, and J. Sakowski. 2004. Genetic testing and pharmacogenomics: Issues for determining the impact to healthcare delivery and costs. The American Journal of Managed Care 10(7): 425–432.

    PubMed  Google Scholar 

  45. Reardon, J. 2011. The “persons” and “genomics” of personal genomics. Personalized Medicine 8(1): 95–107.

    Article  Google Scholar 

  46. Rose, N., and P. Miller. 1992. Political power beyond the state: Problematics of government. The British Journal of Sociology 43(2): 173–205.

    Article  Google Scholar 

  47. Rychetnik, L., P. Hawe, E. Waters, A. Barratt, and M. Frommer. 2004. A glossary for evidence-based public health. Journal of Epidemiology and Community Health 58(7): 538–545.

    PubMed  Article  Google Scholar 

  48. Seshadri, R., F.A. Firgaira, D.J. Horsfall, K. McCaul, V. Setlur, and P. Kitchen. 1993. Clinical significance of HER-2/neu oncogene amplification in primary breast cancer. The South Australian Breast Cancer Study Group. Journal of Clinical Oncology 11(10): 1936–1942.

    PubMed  CAS  Google Scholar 

  49. Slamon, D.J., G.M. Clark, S.G. Wong, W.J. Levin, A. Ullrich, and W.L. McGuire. 1987. Human breast cancer: Correlation of relapse and survival with amplification of the HER-2/neu oncogene. Science 235(4785): 177–182.

    PubMed  Article  CAS  Google Scholar 

  50. Slamon, D.J., W. Godolphin, L.A. Jones, et al. 1989. Studies of the HER-2/neu proto-oncogene in human breast and ovarian cancer. Science 244(4905): 707–712.

    PubMed  Article  CAS  Google Scholar 

  51. Slamon, D.J., B. Leyland-Jones, S. Shak, et al. 2001. Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. The New England Journal of Medicine 344(11): 783–792.

    PubMed  Article  CAS  Google Scholar 

  52. Smart, A., P. Martin, and M. Parker. 2004. Tailored medicine: Whom will it fit? The ethics of patient and disease stratification. Bioethics 18(4): 322–343.

    PubMed  Article  Google Scholar 

  53. Snyderman, R., and R. Sanders Williams. 2003. Prospective medicine: The next health care transformation. Academic Medicine 78(11): 1079–1084.

    PubMed  Article  Google Scholar 

  54. Taylor, S., S. Treloar, K. Barlow-Stewart, M. Stranger, and M. Otlowski. 2008. Investigating genetic discrimination in Australia: A large-scale survey of clinical genetics clients. Clinical Genetics 74(1): 20–30.

    PubMed  Article  CAS  Google Scholar 

  55. Thrall, J.H. 2004. Personalized medicine. Radiology 231(3): 613–616.

    PubMed  Article  Google Scholar 

  56. Tiles, M. 1993. The normal and pathological: The concept of a scientific medicine. The British Journal for the Philosophy of Science 44(4): 729–742.

    Article  Google Scholar 

  57. Willard, H.F., M. Angrist, and G.S. Ginsburg. 2005. Genomic medicine: Genetic variation and its impact on the future of health care. Philosophical Transactions of the Royal Society B: Biological Sciences 360(1460): 1543–1550.

    Article  CAS  Google Scholar 

Download references

Acknowledgments

Thank you to the Australasian Association of Bioethics and Health Law (AABHL) for this distinguished award, the Max Charlesworth Prize in Bioethics, and for assistance with attending the 2011 AABHL conference. Also to Prof. Ian Kerridge and Dr. Wendy Lipworth, thank you for your time and patience with editing and for providing constructive feedback on drafts of this manuscript.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Jacqueline Savard.

Additional information

This paper was submitted for and awarded the Max Charlesworth Prize in Bioethics at the 2011 Australasian Association of Bioethics and Health Law conference.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Savard, J. Personalised Medicine: A Critique on the Future of Health Care. Bioethical Inquiry 10, 197–203 (2013). https://doi.org/10.1007/s11673-013-9429-8

Download citation

Keywords

  • Personalised medicine
  • Health care
  • Neoliberalism
  • Ontology
  • Epistemology
  • Ethics