Making It (Im)personal

Recent years have seen dramatic gains in our understanding of human biology and disease. In my own field of respiratory medicine, it has become abundantly clear that what we call asthma is not a single disease. The term “endotypes” has emerged to reflect the different underlying pathophysiological mechanisms that lead to similar clinical manifestations, leaving us with the question: How best to tackle these several diseases called asthma? I suggest the answer lies in both personalized and impersonalized medicine.

A constellation of genetic predispositions, pathophysiological mechanisms and, importantly, social factors come together to make each case unique. Personalized or precision medicine is aimed at (better) tailoring treatment to these characteristics of specific patients. For truly personalized medicine, the social experience and environmental exposure histories throughout a patient’s entire life, and probably their parents’ and grandparents’ lives, will have to be taken into account. As the pulmonary research community identifies differences among pathogenetic mechanisms operating in the several asthmas, we’re poised to develop therapies that target those pathogeneses in a selective way, through the biologics currently in development or through entirely new approaches.