1. Challenge of personalized health care: To what extent is medicine already individualized and what are the future trends? Author: Walter Fierz Presented by Xiaomin Xu For Journal Club on Sep.13,2005

2. Backgound Before the advent of scientific medicine Lack of standardization Individualize medical care Introduction of the scientific medicine Personal aspects of treatment were endangered Challenge: regain individualism on a scientific basis

3. Personalized medicine Occurred at post-genomic era Individualized medicine is not new New are: Molecular diagnostics based on comprehensive and high-throughput genetic testing & pharmacogenomics Focus of this article: infectious diseases and clinical immunological disorders

4. Six dimensions of PM Disease: disease evolution Environment: the infecting microbe Genes: the molecular traits and mechanisms underlying the individual characteristics of both the patient and the microbe

5. Six dimensions of PM (Cont.) Medication: drug development Health care: health-care process Information management: patient- specific and knowledge-based Properties along these six dimensions are not independent from each other

6. Individual character of infectious diseases Interaction between host and microbes is very individual Individuality: based on many factors Molecular technology has been introduced into the third dimension

7. Individual character of immune responses Innate immune system and adaptive immune system both show high degree of polymorphism Overwhelming complexity of the immune system make personalizing prevention and treatment difficult

8. Within health care process Personalized medicine and patient-centered care are mutually supportive. Put emphasis on the integration of disparate personalized medical approaches and on the integration of fragmented personal records. Personalized information management Clinical laboratory should provide electronic links between personal lab data and electronic information from digital libraries and databases.

9. Social and ethical risks Personal values are at stake: privacy, protection of minorities, prevention of discrimination Regulation: Inform consent in the diagnostic process Clinical lab as trusted intermediaries Legal protection Protect genetic minorities Rational and irrational discrimination

10. Conclusions Personalized medicine is promising Challenge is to adapt the health-care process to the needs of personalized medicine and to cope with its social risks