EDITORIAL Personalized medicine: something old, something new At the level of clinical practice, personalized medicine is in fact nearly as old as recorded history That which has been is that which will be. And In a wonderful manuscript published in 2005 that which has been done is that which will be Sykiotis et al. argue that the pharmacogenetics So there is nothing new under the rinciples underlying our current understandi Ecclesiastes 1: 9 of personalized medicine are in fact traceable to the writings of Hippocrates, the 5th century Qohelet', the author of the biblical book BCE "father of western medicine[2]. Although Ecclesiastes [u], was a kill-joy of the first degree. the authors push the comparison a bit, the article He, or perhaps(though unlikely)she, argued does raise questions about our use of personal hat basically all human activity was futile and ized medicine as the phrase to capture what Fintan r steele repetitive, that 'progress was an apparition, and happening in our time Broad Institute of MIT all that mattered was what came after the wel- Hippocrates worked with the philosophical Harvard, 7 Cambridge Center come embrace of death. Hardly the first person and scientific language of his time, provided by Cambridge, MA 02142, USA that comes to mind for a quote in an editorial the pre-Socratic philosopher Empedocles Tel.+16173243872 on personalized medicine. define sickness as dyscrasia, or an imbalance of STeele@broad. mit. edu Yet there is something about Qohelet's obser- the four humors. The goal of the physician ation that we should take to heart before we to restore the patient to eucrasia or good bal- trumpet the matins of a new medical revolution. ance(i. e, wellness)by addressing the cause of In fact, when we step back from the attendant the disease as revealed by the phenotype hype, it becomes clear that at least part of what Let me offer a theoretical case study. Pythagoras is commonly called personalized medicine' comes to Hippocrates' clinic complaining of sad- is fundamentally nothing new?. Rather, what ness and low energy, his usual excitement about seems to me to be the primary 'newness of per- his mathematical pursuits overcome by a terrible sonalized medicine resides in the new language depression. Hippocrates determines, both from that is emerging. This new language attempts to Pythagoras self description and by visual inspec- ve us the ability to speak more authoritatively tion of the patient's presenting phenotype, that bout the phenotype of disease based on our Pythagoras is suffering from an overabundance growing knowledge of biology. Furthermore, of black bile, or melancholia. The this new language is very much in its infancy, doled out is precise to Pythagoras, including and the phrases and words that we manufacture changing his dietary habits, a temporary spate to mean one thing today will inevitably change of abstinence, and a harsh purging of his bow as the language is eventually codified by clini- els. Following treatment, Pythagoras is better, cal practice. But at the level of clinical practice, though whether that is due to the efficacy of the personalized medicine is in fact nearly as old as treatment or his relief that it is over is unclear. recorded history What has happened? From one perspective, the right treatment was given to the right pater That which has been is that which at the right time. Again, the notion of right'is will be" within the context of the knowledge of the time Personalized medicine-in the sense of the right (the humors), but the treatment was certainly treatment for the right patient at the right time- personalized and even effective has been practiced for millennia. One has to take The four humors as the basis of medical pra the term right in this context with a grain of salt. tice continued to reign for two millennia, an However, within the limitations of the knowledge bit beyond. It grew increasingly ember- uture certa appeared right to both physician and patient. bodily fuid became fair game for testing in ways medicine fsg 102217/17410541.6.1.102009 Future medicine ltd Personalized Medicine (2009)6(1), 1-5 ssN1741-054110.2217/17410541.6.1.1 © 2009 Future Medicine Ltd Personalized Medicine (2009) 6(1), 1–5 ISSN 1741-0541 1 Editorial “At the level of clinical practice, personalized medicine is in fact nearly as old as recorded history.” Fintan R Steele Broad Institute of MIT & Harvard, 7 Cambridge Center, Cambridge, MA 02142, USA Tel.: +1 617 324 3872 fsteele@broad.mit.edu Personalized medicine: something old, something new “That which has been is that which will be. And that which has been done is that which will be done. So there is nothing new under the sun.” – Ecclesiastes 1:9 ‘Qohelet’, the author of the biblical book Ecclesiastes [1], was a kill-joy of the first degree. He, or perhaps (though unlikely) she, argued that basically all human activity was futile and repetitive, that ‘progress’ was an apparition, and all that mattered was what came after the wel￾come embrace of death. Hardly the first person that comes to mind for a quote in an editorial on personalized medicine. Yet there is something about Qohelet’s obser￾vation that we should take to heart before we trumpet the matins of a new medical revolution. In fact, when we step back from the attendant hype, it becomes clear that at least part of what is commonly called ‘personalized medicine’ is fundamentally ‘nothing new’. Rather, what seems to me to be the primary ‘newness’ of per￾sonalized medicine resides in the new language that is emerging. This new language attempts to give us the ability to speak more authoritatively about the phenotype of disease based on our growing knowledge of biology. Furthermore, this new language is very much in its infancy, and the phrases and words that we manufacture to mean one thing today will inevitably change as the language is eventually codified by clini￾cal practice. But at the level of clinical practice, personalized medicine is in fact nearly as old as recorded history. “That which has been is that which will be” Personalized medicine – in the sense of the ‘right treatment for the right patient at the right time’ – has been practiced for millennia. One has to take the term ‘right’ in this context with a grain of salt. However, within the limitations of the knowledge and language of the time, the therapy certainly appeared right to both physician and patient. In a wonderful manuscript published in 2005, Sykiotis et al. argue that the pharmacogenetics principles underlying our current understanding of personalized medicine are in fact traceable to the writings of Hippocrates, the 5th century BCE ‘father of western medicine’ [2]. Although the authors push the comparison a bit, the article does raise questions about our use of personal￾ized medicine as the phrase to capture what is happening in our time. Hippocrates worked with the philosophical and scientific language of his time, provided by the pre-Socratic philosopher Empedocles, to define sickness as dyscrasia, or an imbalance of the four humors. The goal of the physician was to restore the patient to ‘eucrasia’ or good bal￾ance (i.e., wellness) by addressing the cause of the disease as revealed by the phenotype. Let me offer a theoretical case study. Pythagoras comes to Hippocrates’ clinic complaining of sad￾ness and low energy, his usual excitement about his mathematical pursuits overcome by a terrible depression. Hippocrates determines, both from Pythagoras’ self description and by visual inspec￾tion of the patient’s presenting phenotype, that Pythagoras is suffering from an overabundance of black bile, or melancholia. The treatment doled out is precise to Pythagoras, including changing his dietary habits, a temporary spate of abstinence, and a harsh purging of his bow￾els. Following treatment, Pythagoras is better, though whether that is due to the efficacy of the treatment or his relief that it is over is unclear. What has happened? From one perspective, the right treatment was given to the right patient at the right time. Again, the notion of ‘right’ is within the context of the knowledge of the time (the humors), but the treatment was certainly personalized and even effective. The four humors as the basis of medical prac￾tice continued to reign for two millennia, and even a bit beyond. It grew increasingly embel￾lished with other phenotypic markers – every bodily fluid became fair game for testing in ways