Skip to main content

Advertisement

Log in

Personalised Medicine: A Critique on the Future of Health Care

  • Original Research
  • Published:
Journal of Bioethical Inquiry Aims and scope Submit manuscript

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, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • 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 

  • 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 

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

    Article  PubMed  CAS  Google Scholar 

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

    Google Scholar 

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

    Article  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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 

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

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  • 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).

  • 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 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  CAS  Google Scholar 

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

    Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Book  Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  • 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 

  • 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.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

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

    Article  Google Scholar 

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

    Article  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  • 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.

  • 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.

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  • 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 

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

    Google Scholar 

  • 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 

  • 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 

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

    Article  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • 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 

  • 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

Authors and 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

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11673-013-9429-8

Keywords

Navigation