P is not for Person: The Ethical Paradox of P Medicine

This research aims to delve into a paradoxical trend within certain knowledge domains. Specifically, it explores how the pursuit of stratification and the rejection of reductionism can inadvertently lead to a reductionist view of the human person. We argue that contemporary conceptualisations of "P medicine" fail to achieve their intended ethical goals.

In the field of medicine, there is a notable paradigm shift towards individualised approaches. Advances in genomics and data science have fuelled the promise of tailoring medical treatments to each patient's specific needs. This concept, often referred to as "personalised medicine", "precision medicine", "stratified medicine"," systems medicine", or "P4 medicine", leverages vast datasets of genetic, molecular, and clinical data to identify patient subgroups with differential treatment responses. However, these terms, while emphasising individualisation, often neglect subtle ethical distinctions (Ginsburg & Vogelstein, 2002; Gorini & Pravettoni, G. 2010; Hood & Flores, 2012; Schneider, 2013; Pokorska-Bocci et al., 2014; Juengst, et al., 2016; Maier, 2017; Juengst & McGowan, 2018; Jørgensen, 2019).

While all P medicines offer the potential to move beyond disease-centric treatment by analysing individual susceptibilities and therapeutic targets, a sole focus on the disease remains insufficient (Delpierre & Lefèvre, 2023; Stratton & Olson, 2023). William Osler's ideal physician "treats the patient who has the disease," acknowledging the importance of person-centred care (Tomaselli et al., 2020). Person-centred care and P´s medicine appear to represent seemingly divergent philosophies in modern healthcare. The first, emphasises patient autonomy, values, and preferences, while the second leverages individual genetic and biological data for tailored diagnoses and treatments.

This research explores the critical need to reconcile these approaches to achieve optimal healthcare delivery. Reconciling these approaches is not about diminishing the importance of either approach (Cornetta & Brown, 2013; El-Alti et al., 2019). Instead, it's about creating a synergy that leverages the strengths of each. A holistic understanding by integrating the patient's biology, social context, and patient values and goals is crucial for optimising treatment strategies, empowering patients, and achieving better health outcomes. Into the framework of P´s medicine, healthcare professionals can deliver more holistic, patient-centred, and ultimately, more effective care.