 So every medical talk or medical related talk really has to begin with apocrates There are two there are in fact two things science and opinion apocrates says the former begets knowledge and the latter ignorance And he said that you know five centuries before the common era but I would like to add not always and personalized medicine is one of those examples where what you people do what we do is is critically important So let me first talk about this personalized medicine thing It's it's a webster's defines it It's the you as soon as he said that I thought oh crap I got that slide right He defines it is the use of individual genetic information to prevent disease to choose medicines and make other critical decisions about health and I'm gonna argue that this is an Entirely mystical not a medical definition in the course of this talk So here's what I'm going to come to First I want to talk about why this notion of personalized medicine, which is a terrible name is not new Secondly, I want to talk about what is the real science behind what's being claimed in the name of personalized medicine and third I want to kind of demonstrate where these people have made the slip in the mysticism And I think that it'll be interesting for for this group in particular and if not blame it on the morphine Okay, so going back to apocrates. So apocrates basically kind of pulled medicine out of the Initially pulled medicine out of the the clutches of the witch doctors, etc. And and tried to put it on some kind of rational ground In retrospect, we don't think it was that rational, but it was the first attempt. So he based it on the humors So the everybody's familiar with yellow bile or caloric black bile or melancholic Flem phlegmatic Blood or sanguine. So it was phenotype. He was he was kind of defining phenotype in terms of medicine So this was a step forward even though like I said, we laugh about it now much like we'll laugh about chemotherapy in another 10 years but it's it was a Significant step so so let me do a little case study because I once in a while I talked to doctors and they like case studies and it's kind of silly so So a patient comes in to see apocrates and apocrates observes that that he's sad and Has kind of low energy and is legubrious, which I just liked that word and had to get it on the slide So so the diagnosis given the four humors, you know with consult the medical dictionary is a melancholia or an overabundance of the black bile and so there's a treatment and Includes dietary changes usually not ones people liked Abstinence usually not something people liked and purging definitely something most people didn't like But if the patient got better the diagnosis proved itself and Humors went their merry way in the and the patient came back with the next round of whatever they've had So in a sense apocrates was really doing personalized medicine. He grasped the centrality of Human variability or what was called idiosyncrasia? The idea was to have eukrasia, you know The balance of the humors idiosyncrasia meant there was a bunch of different balances and a bunch of different people and it was all kind Of personalized to those folks He also believed that this variability among folks in the balance of their humors affected both the disease susceptibility and the therapeutic response to whatever Whatever therapy they were able to offer and then he always emphasized that that clinical practice must be personalized Even though he didn't use that word to the phenotype so personalized medicine. Let's just start with that It's not really anything new. It's just the term that's taken on some additional meaning that we'll talk about So the humors continued for nearly two centuries in fact, you know The rumor is George Washington was blood to death as a result of a humor diagnosis of various kinds Strengthened by Galen of course They kind of filled in phenotype various ways tried to measure more things So they would collect blood and urine and sweat and feces and test them But we're not talking quest diagnostics here. I'll just spare you some of the uglier details of the testing But the most fascinating thing was the humors really didn't Explain everything and so what fills in is a lot of other stuff astrology or theology I did not really theology, but I called proxies the actual kind of odd religious practices They played major roles kind of filling in wherever ignorance remains. So Pocrates pushed the line a little further, but the whole back ends still belong to to So and and we see this pattern repeated several times as we go ahead This is not going to be a history of the science of medicine just a couple highlights. So so paracelsus Was an alchemist who turned to chemistry because in the town He was working in Basel, Switzerland He noted that the miners who were inhaling these various chemicals were actually having fairly ill effects from them And he was able to do kind of a controlled experiment figure out it was due to the chemicals So he began to broaden the understanding in terms of environmental forces not just what's going on inside your humors He started to realize there's such a thing as dosage. It's a little bit of a good thing is is fine Too much of a good thing is really bad But it was all steep still in this kind of mystical alchemy Alchemy language and practice But it was a step forward Harvey the experimentalist kind of cut people up was able to prove that that Galen's Understanding of how the humors flux through the body was wrong just by demonstrating what the circulatory system did But it's still like I said took centuries to replace humor-based medicine Lou and hook Kind of expanded beyond what the human eye could see so what Hippocrates saw in the clinic in terms of his patient's appearance There was like more to see The world within us and the world without and but it expands what we could see But not necessarily what we could understand but it pushed the line a little further So this I call it scalpel scopes in chemistry. It kind of is Redefining phenotype. It's getting it richer So we got a better observational sense and start to put together pieces and push back the line of ignorance a little bit And it's a side note it kind of and this become important later it Coalesced medicine around basically organ systems and stuff which turns out as a terrible way to organize medicine But the lines getting pushed back So just leaping ahead To this century, but now we have the emergence of what's called real personalized medicine As compared to the fake personalized medicine practiced by Hippocrates and many fine doctors throughout This is a cover of science from a couple years ago the molecule or the breakthrough of the year about human genetic variability This new personalized medicine this brave new world is driven by technology the coming together of really good analytical tools with Significant it power to deal with the massive amounts of data. It's basically science-based And it's hugely overhyped