Evidence for personalised medicine: mechanisms, correlation, and new kinds of black box

Theoretical Medicine and Bioethics 40 (2):103-121 (2019)
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Abstract

Personalised medicine has been discussed as a medical paradigm shift that will improve health while reducing inefficiency and waste. At the same time, it raises new practical, regulatory, and ethical challenges. In this paper, we examine PM strategies epistemologically in order to develop capacities to address these challenges, focusing on a recently proposed strategy for developing patient-specific models from induced pluripotent stem cells so as to make individualised treatment predictions. We compare this strategy to two main PM strategies—stratified medicine and computational models. Drawing on epistemological work in the philosophy of medicine, we explain why these two methods, while powerful, are neither truly personalised nor, epistemologically speaking, novel strategies. Both are forms of correlational black box. We then argue that the iPSC models would count as a new kind of black box. They would not rely entirely on mechanistic knowledge, and they would utilise correlational evidence in a different way from other strategies—a way that would enable personalised predictions. In arguing that the iPSC models would present a novel method of gaining evidence for clinical practice, we provide an epistemic analysis that can help to inform the practical, regulatory, and ethical challenges of developing an iPSC system.

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Author Profiles

Mary Jean Walker
La Trobe University
Katrina Hutchison
Macquarie University

References found in this work

How the laws of physics lie.Nancy Cartwright - 1983 - New York: Oxford University Press.
Nature's capacities and their measurement.Nancy Cartwright - 1989 - New York: Oxford University Press.
Abstraction and the Organization of Mechanisms.Arnon Levy & William Bechtel - 2013 - Philosophy of Science 80 (2):241-261.

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