How precision medicine and screening with big data could increase overdiagnosis

Vogt, Henrik; Green, Sara; Ekstrøm, Claus Thorn; Brodersen, John

doi:10.1136/bmj.l5270

Cited by 43 publications

(35 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Substantial questions about efficacy in terms of long-term behavioural change and health outcomes remain. Related concerns are those of overdiagnosis in healthy individuals (101) , cost-benefit and impacts on health inequalities. Dietary and lifestyle choices are influenced by a broad range of socioeconomic factors including income, education, social networks and the built environment (102) .…”

Section: Discussionmentioning

confidence: 99%

From personalised nutrition to precision medicine: the rise of consumer genomics and digital health

Moore

2020

Proc. Nutr. Soc.

View full text Add to dashboard Cite

Advances in genomics generated the concept that a better understanding of individual characteristics, e.g. genotype, will lead to improved tailoring of pharmaceutical and nutritional therapies. Subsequent developments in proteomics and metabolomics, in addition to wearable technologies for tracking parameters, such as dietary intakes, physical activity, heart rate and blood glucose, have further driven this idea. Alongside these innovations, there has been a rapid rise in companies offering direct-to-consumer genetic and/or microbiome testing, in combination with the marketing of personalised nutrition services. Key scientific questions include how disparate datasets are integrated, how accurate are current predictions and how these may be developed in the future. In this regard, lessons can be learned from systems biology, which aims both to integrate data from different levels of organisation (e.g. genomic, proteomic and metabolomic) and predict the emergent behaviours of biological systems or organisms as a whole. The present paper reviews the origins and recent advancement of ‘big data’ and systems approaches in medicine and nutrition. Conclusions are that systems integration of multiple technologies has generated mechanistic insights and informed the evolution of precision medicine and personalised nutrition. Pertinent ethical issues include who is entitled to access new technologies and how commercial companies are storing, using and/or re-mining consumer data. Questions about efficacy (both long-term behavioural change and health outcomes), cost-benefit and impacts on health inequalities remain to be fully addressed.

show abstract

Section: Discussionmentioning

confidence: 99%

From personalised nutrition to precision medicine: the rise of consumer genomics and digital health

Moore

2020

Proc. Nutr. Soc.

View full text Add to dashboard Cite

show abstract

“…Some have criticized the concept of PM (see e.g. Feiler et al 2017 ; Coote and Joyner 2015 ; Vogt et al 2016 ; Muse and Topol 2019 ; Maughan 2017 ; Vogt et al 2019 ), and one could claim that there is a continuum from traditional medicine to genomic medicine, understood as the production and use of personal genomic information based on digital technologies, which will increasingly be the standard within many healthcare specialities for diagnostic, prognostic and therapeutic purposes. However, we will take for granted that these technologies provide a qualitative difference in the approach to medical services, justifying the PM label.…”

Section: Pm and Genomic Medicine—a New Approach To Diagnostics And Trmentioning

confidence: 99%

“…PM is an interdisciplinary endeavour, and relies on a number of complementary areas of expertise. This situation may create new opportunities but also result in novel kinds of mistakes, including excessive use of the tools, with increased tendencies towards overdiagnosis (Vogt et al 2019 ). Digitalization involves new kinds of expertise, but many of the expert tasks within medicine and health care are, in addition, replaced by technology through high throughput analysis, automation and artificial intelligence.…”

Section: Introductionmentioning

confidence: 99%

Personalized medicine, digital technology and trust: a Kantian account

Myskja

Steinsbekk

2020

Med Health Care and Philos

View full text Add to dashboard Cite

Trust relations in the health services have changed from asymmetrical paternalism to symmetrical autonomy-based participation, according to a common account. The promises of personalized medicine emphasizing empowerment of the individual through active participation in managing her health, disease and well-being, is characteristic of symmetrical trust. In the influential Kantian account of autonomy, active participation in management of own health is not only an opportunity, but an obligation. Personalized medicine is made possible by the digitalization of medicine with an ensuing increased tailoring of diagnostics, treatment and prevention to the individual. The ideal is to increase wellness by minimizing the layer of interpretation and translation between relevant health information and the patient or user. Arguably, this opens for a new level of autonomy through increased participation in treatment and prevention, and by that, increased empowerment of the individual. However, the empirical realities reveal a more complicated landscape disturbed by information ‘noise’ and involving a number of complementary areas of expertise and technologies, hiding the source and logic of data interpretation. This has lead to calls for a return to a mild form of paternalism, allowing expertise coaching of patients and even withholding information, with patients escaping responsibility through blind or lazy trust. This is morally unacceptable, according to Kant’s ideal of enlightenment, as we have a duty to take responsibility by trusting others reflexively, even as patients. Realizing the promises of personalized medicine requires a system of institutional controls of information and diagnostics, accessible for non-specialists, supported by medical expertise that can function as the accountable gate-keeper taking moral responsibility required for an active, reflexive trust.

show abstract

“…The more ignorant, the more arrogant, and reckless. It is convenient to restrain the excessive expectations that in prevention are almost infinite, sometimes fueled by a Medicine that promises impossible, almost eternal youth; for example, with Precision Medicine and the "Big Data" 14 .…”

Section: How To Avoid Preventive Overuse?mentioning

confidence: 99%

Medicina de Familia y Comunidad y su papel en evitar los excesos sanitarios (preventivos, diagnósticos, terapéuticos y rehabilitadores)

Gérvas

Oliver²,

Pérez-Fernández

2020

Ciênc. saúde coletiva

View full text Add to dashboard Cite

Resumen En Medicina es clave “ofrecer el 100% de lo que se precisa y evitar el 100% de lo que no se precisa”. Lamentablemente, es difícil cumplir con esta cuestión clave y generalmente se ofrece más de lo que se precisa y no se evita todo lo que no se precisa. Este texto es una revisión no sistemática con objetivo docente en que se revisa el problema general en atención primaria y se proponen formas de evitar los excesos y defectos respecto a intervenciones preventivas, diagnósticas, terapéuticas y de rehabilitación. Saber no hacer es ciencia y arte que se enseña poco y se practica menos. Los excesos que dañan son parte casi diaria de la práctica clínica, en prevención, diagnóstico, tratamiento y rehabilitación. Es imprescindible fomentar “el arte y la ciencia de no hacer”.

show abstract

How precision medicine and screening with big data could increase overdiagnosis

Abstract: Precision medicine based on big data promises to revolutionise disease prevention but increases the challenge of determining which abnormalities will be clinically important, argue Henrik Vogt and colleagues

Cited by 43 publications

References 24 publications

From personalised nutrition to precision medicine: the rise of consumer genomics and digital health

From personalised nutrition to precision medicine: the rise of consumer genomics and digital health

Personalized medicine, digital technology and trust: a Kantian account

Medicina de Familia y Comunidad y su papel en evitar los excesos sanitarios (preventivos, diagnósticos, terapéuticos y rehabilitadores)

Contact Info

Product

Resources

About