I am so at home in Dublin, more than any other city, that I feel it has always been familiar to me. It took me years to see through its soft charm to its bitter prickly kernel - which I quite like too.

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Customised Care

Shaun R McCann
Perhaps “personalised/precision medicine” will become the norm in years to come, but I think it is timely to remember the words of the great Canadian physician William Osler: “The good physician treats the disease. The great physician treats the patient.” Nevertheless there has been a lot of discussion about “precision medicine” in the printed media recently. The early success of treating Hodgkin disease and childhood leukaemia in the 1960s with cytotoxic drugs (drugs which kill dividing cells) heralded a new age in medicine, and many thought that if similar approaches were taken with other cancers they would be cured. However, combination chemotherapy is relatively toxic as the drugs damage normal as well as tumour cells. Sadly therefore, the majority of cancers remain incurable. The lack of success of this approach might in part be due to the rather unsubtle application of a “one size fits all” approach. Now we are embarking on a different approach known as “precision medicine”. Many people believe that precision medicine will lead to a fundamental understanding of the complex interplay between genetics, epigenetics, nutrition, environment and clinical presentation, thus facilitating the development of effective prevention and treatment. I will attempt to define precision medicine and contextualise it for non-medical readers. Needless to say the term originated in the USA, where many medical issues are referred to using military terminology. (A good example is “the war on cancer”.) Precision medicine (PM) proposes the customisation of healthcare, with medical decisions, practices, and/or products tailored to an individual patient’s disease. “Collateral damage” should be minimised. Diagnostic testing can be used to select appropriate and optimal therapies based on a patient’s genetic makeup or other molecular or cellular analyses. A similar term, “personalised medicine”, is also in vogue. The National Cancer Institute (NCI), a division of the National Institutes of Health (NIH) in Bethesda, Maryland, defines personalised medicine as A form of medicine that uses information about a person’s genes, proteins, and environment to prevent, diagnose, and treat disease. In cancer, personalized medicine uses specific information about a person’s tumor to help diagnose, plan treatment, find out how well treatment is working, or make a prognosis. Examples of personalised medicine include using targeted therapies to treat specific types of cancer cells, such as HER2-positive breast cancer cells, or using tumor marker testing to help diagnose cancer. Although both terms may be subtly different from each other, in practice they…

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