April 08, 2011
This question was posed by a reader in response to my previous blog post about the anticonvulsant medication valproic acid and drug-induced liver injury that occurs in a modest percentage of patients where the risk disproportionately involves individuals with a particular gene polymorphism.Measuring or predicting risk for an individual vs. measuring or predicting risk for populations is an important distinction to make. Epidemiologists call applying a population result to a person the "atomistic fallacy." The converse (applying risk that is known for an individual or for a small group to a larger population that is different from the individual or small group) is called the "ecological fallacy."
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January 28, 2011
A reader emailed me to ask: In follow-up to your previous blog post, is there a comparable example for women's health?To be exactly comparable, we'd be talking about genomics-based personalized tailoring of cancer screening-related diagnostic testing normal-ranges or decision-levels, where the diagnostic involves a customary biomarker molecule that is used to assess risk of cancer and guide further evaluation or intervention.
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January 18, 2011
Most people think of “personalized medicine” as choosing the best (most-effective, safest, etc.) treatment according to the details of the attributes of the person, including genetic and genomic attributes. What's not generally recognized is that personalized medicine also involves personalizing the decision-levels of diagnostic tests for the individual--taking the numerical limits of the reference ranges (“normal ranges”) of laboratory tests and vital signs and other diagnostic and monitoring procedures, and tailoring those ranges to reflect what is “normal” for persons with those specific attributes.
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