Miriam Solomon, Temple University – Precision Medicine

If you have a certain disease, you get a certain medical treatment.  Right?

Miriam Solomon, professor of philosophy at Temple University, explains how precision medicine may change this way of thought.

Professor Solomon works in the areas of philosophy of science, social epistemology, medical epistemology, medical ethics and gender and science. She is the author of Social Empiricism (MIT Press, 2001), editor of several special journal issues, and author of many journal articles.  Making Medical Knowledge, a book on the epistemology of medicine, exploring medical consensus conferences, evidence-based medicine, translational medicine, and narrative medicine, was published with Oxford University Press (UK) on April 2, 2015.

Professor Solomon is active on the Temple University Hospital Ethics Committee and serves on the Executive Committee of the College of Liberal Arts.

Professor Solomon is on the Editorial Board of the journals Philosophy of Science and Hypatia. She is on the Editorial Board of theStanford Encyclopedia of Philosophy in the area of philosophy of science.  She is on the organizing committee of the Philosophy of Medicine Roundtable, the Advisory Board of the Society for Philosophy of Science in Practice, a panelist at askphilosophers.org and served on the Governing Board of the Philosophy of Science Association from 2011-14.  Miriam Solomon was a founding co-chair of the Philosophy of Science Association Women’s Caucus.

Professor Solomon is a Fellow of the College of Physicians of Philadelphia.

Precision Medicine

This year President Obama announced funding for a new Precision Medicine Initiative. What is meant by “precision medicine?”

Traditional medical research proceeds from the premise that different cases of the same disease have the same underlying mechanisms. People with cystic fibrosis should all be treated in same way, with chest percussion, oral enzymes, and other standard treatments. With such therapies, the average life expectancy for people with cystic fibrosis has increased from infancy to early middle age. However, molecular and genetic therapies developed on this model have been less successful.

Precision medicine proceeds from a different premise: patients with clinically similar disease may have different underlying mechanisms, and treatments should be devised for patient subgroups sharing the same mechanism, rather than for all patients together.  The focus is on the ways in which patients differ rather than on the ways in which they are the same.  This sounds like a less efficient strategy, because research is needed for several subgroups of patients rather than for one group.  Despite this, it is showing promise in the area of molecular therapies.  For example, the subgroup with the G551D mutation was the first to receive a targeted molecular therapy, Ivacaftor, which showed effectiveness. Following this, researchers developed another targeted molecular therapy, adding Lumacaftor to Ivacaftor, for the treatment of a second cystic fibrosis mutation, deltaF508.  Research on treatments for other cystic fibrosis genetic mutations is proceeding. We can anticipate further stepwise increases in life expectancy for people with cystic fibrosis.

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Making Medical Knowledge – Miriam Solomon