Personalized medicine in historical perspective: from antiquity to the genome age

An international conference at the Institute of the History of Medicine, Johns Hopkins University, May 15-16, 2014 Organized by Nathaniel Comfort (comfort@jhmi.edu) and Gianna Pomata (gpomata1@jhmi.edu). We often hear the claim that “personalized medicine,” a cutting-edge topic in biomedicine today, is also one of the oldest concepts in the healing arts. Its advocates promise to eliminate “one size fits all” medicine, and revitalize an older approach, in which the individual patient was pre-eminent. Yet, surprisingly, very little historical research substantiates this claim. When we turn to the history of pre-modern medicine, we do not find in-depth historical studies on this issue, beyond a generic admission that Hippocratic-Galenic medicine was based on a widespread expectation (on the part of both healer and patient) of individualized medical care. Similarly, when we turn to the history of modern scientific medicine, we find little attention to the continuities and discontinuities between pre-modern and modern concepts of the individual and the population, and how an emphasis on one or the other shaped medical views. Moreover, the main shifts in the conceptualization of patient individuality in modern scientific medicine remain poorly understood, and no scholarly effort to date has attempted to put the contemporary revival of personalized medicine in long-term perspective. This conference will address these issues by exploring the history of individualized medicine from pre-modern to contemporary medical cultures. We will focus on three fundamental areas of inquiry: 1) What were the intellectual, cultural and social assumptions of individualized medical care in pre-modern medicine? What role did concepts such as crasis, constitution, temperament, and diathesis play in establishing the biographical (or, as Owsei Temkin had it, the physiological) notion of disease that was at the core of the Hippocratic-Galenic tradition? Some of these concepts, such as constitution and diathesis, crossed the divide between pre-modern and modern scientific medicine. How were they transformed in this process? 2) A personalized approach to medical care is often contrasted with a “one size fits all” approach. We are interested in identifying and exploring key examples of this tension in both pre-modern and modern medicine. For example: did Paracelsian medicine in early modern Europe imply a shift away from the traditional individualized regimen for disease prevention and cure? What role did the introduction of vaccination and the rise of bacteriology play in this respect in the 19th century? Was the revival of constitutional medicine in the early 20th century a reaction to the ascendancy of the germ theory of disease? 3) How did the notion of patient individuality evolve in modern scientific medicine? This notion dramatically changed over the 19th and 20th centuries, as medicine narrowed its scope from the whole person to organs and tissues, to proteins, DNA sequences, and single nucleotides. Key episodes in this story seem to be Archibald Garrod’s redefinition of the Hippocratic/Galenic notion of diathesis as “chemical individuality” and the subsequent development of Garrodianism as a powerful intellectual trend in 20th-century medicine; the development of the immunological view of the self from Elie Metchnikoff and Paul Ehrlich to Peter Medawar and Macfarlane Burnet; and most importantly the rise of genetic medicine and pharmacogenomics. What, if any, are the intellectual connections between these developments? Which philosophical and scientific assumptions, and which social trends, have oriented the bio-medical redefinition of patient individuality over the course of the 20th century and the beginning of the 21st?