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The prospects of precision psychiatry

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Abstract

Since the turn of the twenty-first century, biomedical psychiatry around the globe has embraced the so-called precision medicine paradigm, a model for medical research that uses innovative techniques for data collection and analysis to reevaluate traditional theories of disease. The goal of precision medicine is to improve diagnostics by restratifying the patient population on the basis of a deeper understanding of disease processes. This paper argues that precision is ill-fitting for psychiatry for two reasons. First, in psychiatry, unlike in fields like oncology, precision medicine has been understood as an attempt to improve medicine by casting out, rather than merely revising, traditional taxonomic tools. Second, in psychiatry the term “biomarker” is often used in reference to signs or symptoms that allow patients to be classified and then matched with treatments; however, in oncology “biomarker” usually refers to a disease mechanism that is useful not only for diagnostics, but also for discovering causal pathways that drug therapies can target. Given these differences between how the precision medicine paradigm operates in psychiatry and in other medical fields like oncology, while precision psychiatry may offer successful rhetoric, it is not a promising paradigm.

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Notes

  1. For a description and analysis of these terms, see [3, 6,7,8,9,10,11,12,13].

  2. For a review of these and other biomarkers of depression, see [30].

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Acknowledgements

Thanks to our colleagues Steeves Demazeux and Lara Keuck for ongoing conversations about these themes, and to Katelyn MacDougald for stellar editing.

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  1. Bard College, Annandale-on-Hudson, NY, USA

    Kathryn Tabb

  2. University of Bordeaux, Bordeaux, France

    Maël Lemoine

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Correspondence to Kathryn Tabb.

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Tabb, K., Lemoine, M. The prospects of precision psychiatry. Theor Med Bioeth 42, 193–210 (2021). https://doi.org/10.1007/s11017-022-09558-3

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