在个性化癌症医学临床试验中再现正常和病理现象

IF 1.3 4区 医学 Q4 SOCIAL SCIENCES, BIOMEDICAL Biosocieties Pub Date : 2024-06-16 DOI:10.1057/s41292-024-00329-y
Nadav Even Chorev, Dani Filc
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摘要

被称为 "个性化医学 "的医疗实践,理想的做法是利用病人所有可能的特征来预测疾病的易感性和对治疗的反应,但主要是利用个人独特的分子构成来量身定制治疗方案。医疗实践的这一变化也意味着认识论向 "分子化 "的转变:现在,人们通过生命的基本组成单元来理解和控制个体和疾病。在本文中,我们认为个性化医疗的基础是继续将病理状态理解为对正常状态的定量偏离。在这一点上,我们以法国哲学家乔治-康吉伦(Georges Canguilhem)的批判为基础。个性化癌症医学将每位患者的癌症视为单一的,这意味着没有 "正常 "基线可用于比较个体病理学。我们对近年来的个性化癌症临床试验案例进行了分析,结果表明,每项试验都显示出对病理学的定量理解,这让人联想到过去的思维模式,主要有两种模式:对癌症病理学的分子化解释和对靶向疗法疗效的定量测量。我们将这一分析置于对历史医学转变和当前个性化医学研究的更广泛讨论中,以概述这种连续性形式的意义。
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Reproducing the normal and the pathological in personalized cancer medicine clinical trials

The medical practice termed Personalized Medicine ideally uses all the patient’s possible characteristics in predicting disease predisposition and response to therapy, but primarily employs the individual’s unique molecular make-up in the tailoring of treatment. This change in medical practice also entails an epistemic shift towards ‘molecularization’: individuals and disease are now understood and governed through life’s basic building blocks. In this paper we argue that underlying personalized medicine is a continued understanding of the pathological state as a quantitative deviation from a normal state. In this we build on the critique of French philosopher Georges Canguilhem who positioned the quantitative interpretation of the pathological in nineteenth century medical thinking. Personalized cancer medicine takes each patient’s cancer as singular, implying that there is no ‘normal’ baseline for comparing individual pathology. We analyze cases of personalized cancer clinical trials from recent years to show that each displays a quantitative understanding of the pathological reminiscent of past thinking in two main modes: a molecularized interpretation of cancer pathology and a quantitative measuring of targeted therapy efficacy. We situate the analysis in broader discussions of historical medical shifts and in current studies of personalized medicine, to outline implications of this form of continuity.

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来源期刊
Biosocieties
Biosocieties SOCIAL SCIENCES, BIOMEDICAL-
CiteScore
3.40
自引率
6.20%
发文量
23
期刊介绍: BioSocieties is committed to the scholarly exploration of the crucial social, ethical and policy implications of developments in the life sciences and biomedicine. These developments are increasing our ability to control our own biology; enabling us to create novel life forms; changing our ideas of ‘normality’ and ‘abnormality’; transforming our understanding of personal identity, family relations, ancestry and ‘race’; altering our social and personal expectations and responsibilities; reshaping global economic opportunities and inequalities; creating new global security challenges; and generating new social, ethical, legal and regulatory dilemmas. To address these dilemmas requires us to break out from narrow disciplinary boundaries within the social sciences and humanities, and between these disciplines and the natural sciences, and to develop new ways of thinking about the relations between biology and sociality and between the life sciences and society. BioSocieties provides a crucial forum where the most rigorous social research and critical analysis of these issues can intersect with the work of leading scientists, social researchers, clinicians, regulators and other stakeholders. BioSocieties defines the key intellectual issues at the science-society interface, and offers pathways to the resolution of the critical local, national and global socio-political challenges that arise from scientific and biomedical advances. As the first journal of its kind, BioSocieties publishes scholarship across the social science disciplines, and represents a lively and balanced array of perspectives on controversial issues. In its inaugural year BioSocieties demonstrated the constructive potential of interdisciplinary dialogue and debate across the social and natural sciences. We are becoming the journal of choice not only for social scientists, but also for life scientists interested in the larger social, ethical and policy implications of their work. The journal is international in scope, spanning research and developments in all corners of the globe. BioSocieties is published quarterly, with occasional themed issues that highlight some of the critical questions and problematics of modern biotechnologies. Articles, response pieces, review essays, and self-standing editorial pieces by social and life scientists form a regular part of the journal.
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