Toward precision medicine for depression: admitting ignorance and focusing on failures

I first recognized what R. Perlis1 calls “artisanal practice” as a medical student in Liberia. Witch doctors – basically the local primary and psychiatric care providers at the time – regularly engaged in “throwing the bones”. Chicken bones, often in a bag but sometimes in hand, were shaken and thrown on the ground, resulting in a unique pattern which served as the basis for recommendation(s) offered to each “patient”. “Throwing the bones” was common and well accepted. So much so that it was rare to have dehydrated neonates arrive at the hospital without dung spread over their depressed fontanelles, courtesy of the “doctor”. Personalized care – maybe; precision medicine – not so much.