Author:Nadav Even Chorev (European Institute of Oncology)
Paper short abstract:
A relational view of patients was proposed against the focus on molecular aspects of disease in new biomedical practices that decontextualizes patients. I examine possibilities of accounting for wider contexts in such practices, using a qualitative case-study of a personalized cancer clinical trial.
Paper long abstract:
The focus on genomic and other molecular 'omic' facets of disease as keys for treatment in personalized medicine, has been criticized as reductive and as uprooting patients from wider contexts. Instead, a relational understanding of personhood was proposed. Patients are not only embedded in multiple social, political and environmental contexts. They are constitutively 'becoming with' bacteria, fetal cells, larger organisms, environments etc. It is claimed that if incorporated into clinical practice, such an approach may lead to better outcomes.
Here I draw on a case-study of a personalized cancer clinical trial to reflect on the possibility of such an approach in new configurations of medical practice. The trial makes use of predictive information technologies to tailor suitable therapies for each patient, matched according to identified alterations in DNA in pathological tissues, or by identifying dysregulated genes compared between normal and abnormal tissues.
A qualitative analysis of clinical decision-making processes in the trial shows that, despite personalized medicine's vision of encompassing all the patient's life aspects into tailored, precise and effective interventions, the need to produce clinical solutions takes preference over relationality. As cancer clinical trials increasingly rely on algorithms for matching therapies, based on molecular variation, decontextualizing effects on personhood are exacerbated. The result is less 'precise' medical practices then initially intended. I argue, that the use of predictive information technologies processing molecular data to produce treatment options, therefore challenges the possibility of relationality in practice. I examine whether and how wider contexts can be accounted for in similar endeavors.
Precision medicine at the crossroads: meeting the micro and macro, the molecular and social in new medical strategies