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Concepts of interest in the comprehensive care of patients with multi-morbidity (Conceptos de interés en la atención integral de los pacientes con multimorbilidad )

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Cristian Ramos-Vera at University Cesar Vallejo
Cristian Ramos-Vera
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Abstract

Two concepts of interest for the improvement in the integral attention in patients with comorbidity are reported. Se reporta dos conceptos de interes para la mejora en la atención integral en pacientes con comorbilidad.
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CARTA AL EDITOR
Conceptos de interés en la atención
integral de los pacientes con
multimorbilidad
Concepts of interest in the comprehensive
care of patients with multi-morbidity
Sr. Editor:
El interesante artículo «La atención sanitaria a pacientes
con multimorbilidad. La percepción de los profesionales»
de Tambo-Lizalde et al.1 reporta que hay dificultades para
ofrecer una atención más integral a los pacientes con mul-
timorbilidad.
La multimorbilidad (la coexistencia de más de una
enfermedad crónica en un individuo) se ha convertido en
un desafío importante para los sistemas de salud2 tanto
en países de ingresos altos como en países de ingresos
bajos y medios, donde las poblaciones envejecen más
rápidamente3. Una de las definiciones de la multimorbili-
dad que puede orientar hacia una mejor atención integral
está basado en la perspectiva de sistemas adaptativos com-
plejos (CAS) cuya definición se basa en la manifestación de
procesos fisiológicos interconectados dentro de un individuo
en su entorno sociocultural4. Estas redes bioconductuales y
socioambientales pueden verse afectados por los sistemas
de estrés, ocasionando alteraciones fisiológicas que pertur-
ban las diferentes redes internas y sociales4.
El enfoque de Sturmberg et al.4 considera relevante la
comprensión de los diversos procesos patológicos subyacen-
tes internos y externos en la manifestación de un estado de
desregulación fisiológica que conlleva a la multimorbilidad,
siendo un punto importante para los servicios de atención
integral. Es más probable con el abordaje de los múltiples
factores causales del estado comórbido lograr resultados de
salud óptimos donde las intervenciones biomédicas y psico-
sociales se consideren al mismo tiempo4.
De acuerdo con los hallazgos de Tambo-Lizalde et al.1,
quienes
sen˜alan
una mayor
percepción
de
baja
calidad
en
la atención integral debido al enfoque centrado más en la
enfermedad individual. Siendo posible mejorar estos
servicios si se abordara con una mejor comprensión multi-
dimensional del CAS sobre los procesos de la enfermedad y
el control de la calidad de vida del paciente, tales como:
el apoyo social, estilo de vida, comportamientos de salud,
el medio ambiente y el nivel socioeconómico como otros 46
posibles determinantes de la enfermedad. 47
Otro concepto útil que puede complementar el modelo 48
de Sturmberg et al.4 es la personomía, que se refiere a la 49
situación psicosocial y las circunstancias únicas de vida del 50
paciente que pueden alterar el comportamiento de la enfer- 51
medad y la respuesta al tratamiento5,6. Aquello favorece 52
una mejor comprensión de la patogenia y el tratamiento, 53
brindando una atención más personalizada que considere 54
el mundo interno o experiencia subjetiva del paciente. 55
Además, integra no solo la singularidad biológica referida 56
por Sturmberg et al.4, sino las circunstancias de vida 57
externa, por ejemplo: las interacciones del paciente con 58
el sistema médico, las creencias de salud y cómo afronta 59
su enfermedad, que proporciona un valor agregado a los 60
diagnósticos e intervenciones6. 61
Ambos conceptos son importantes para una atención cen- 62
trada en los pacientes con multimorbilidad, coordinado y 63
adaptado a sus necesidades y preferencias, caracterizado 64
por un enfoque más humanista y holístico de la salud, que 65
ubica las necesidades y la experiencia de los pacientes con 66
multimorbilidad en el centro de la organización de la aten- 67
ción médica. 68
Financiación 69
Este trabajo no ha recibido ningún tipo de financiación. 70
Conflicto de intereses 71
Los autores declaran no tener ningún conflicto de intereses. 72
Bibliografía 73
1.
Tambo-Lizalde E, Febrel Bordejé M, Urpí-Fernández AM, Abad- 74
Díez JM. La atención sanitaria a pacientes con multimorbilidad. 75
La percepción de los profesionales. Aten Primaria. 2021, 76
http://dx.doi.org/10.1016/j.aprim.2020.05.013. 77
2.
Valderas JM, S t a r fi e l d B , S i b ba l d B , Salisbury C, Roland 78
M. Defining comorbidity: implications for understanding 79
health and health services. Ann Fam Med. 2009; 7:357---63, 80
http://dx.doi.org/10.1370/afm.983. 81
3.
Arokiasamy P, Uttamacharya U, Jain K, Biritwum RB, Yawson AE, 82
Wu F, et al. The impact of multimorbidity on adult physical and 83
mental health in low- and middle-income countries: what does 84
the study on global ageing and adult health (SAGE) reveal? BMC 85
Med. 2015;13, http://dx.doi.org/10.1186/s12916-015-0402-8.
https://doi.org/10.1016/j.aprim.2021.101969
0212-6567/©
2021
El
Autor(s).
Publicado
por
Elsevier
Espan˜a,
S.L.U.
Este
es
un
art´ıculo
Open
Acce ss
bajo
la
licencia
CC
BY-NC-ND
(http://
creativecommons.org/licenses/by-nc-nd/4.0/).
+Model
APRIM 101969 1-- 2
ARTICLE IN PRESS
Atención Primaria
www.elsevier.es/ap
Cómo citar este artículo: C.A. Ramos-Vera, Conceptos de interés en la atención integral de los pacientes con multimor-
bilidad, Atencion Primaria, https://doi.org/10.1016/j.aprim.2021.101969
C.A. Ramos-Vera
86 4. Sturmberg JP, Bennett JM, Martin CM, Picard M. ‘Multimorbidity’
87 as the manifestation of network disturbances. J Eval Clin Pract.
88 2017;23:199---208, https://doi.org/10.1111/jep.12587.
89 5. Ziegelstein RC. Personomics. JAMA Intern Med. 2015;175:888---9,
90 http://dx.doi.org/10.1001/jamainternmed.2015.0861.
91 6. Ziegelstein RC. Personomics: The Missing Link in the Evolution
92 from Precision Medicine to Personalized Medicine. J Pers Med.
2017;7:11, http://dx.doi.org/10.3390/jpm7040011.
Cristian Antony Ramos-Vera Q1
Área de investigación. Facultad de Ciencias de la Salud.
Universidad Cesar Vallejo, Lima, Perú
Correo electrónico: cristony 777@hotmail.com 93
2
+Model
APRIM 101969 1-- 2
ARTICLE IN PRESS
... La representación gráfica favorece a los profesionales clínicos una mejor interpretación y conocimiento de la información derivada de la investigación para una atención integral específica orientada al grupo de estudio que pueda resultar en una intervención más concreta y toma de decisiones clínicas más concisas, a partir de los resultados obtenidos, desde la perspectiva de sistemas modelos complejos y aspectos clínicos esenciales como la comorbolidad y la inclusión de síntomas y signos transdiagnósticos ante la complejidad de diversos estados de salud de mayor riesgo ante el contexto pandémico actual. (12) El uso de tales características en un sistema de red permite una mayor explicación del funcionamiento de diversas condiciones de salud vinculadas al impacto de la COVID-19 y cómo sus mecanismos etiológicos interactúan entre sí. ...
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... La prevención de los síntomas centrales puede reducir la comorbilidad reportada, es decir que una menor medida del estado de ánimo depresivo tiende a generar menores relaciones con los síntomas emocionales del miedo por COVID-19, esto es esencial para los profesionales de las ciencias de la salud y del comportamiento que busquen desarrollar futuras intervenciones ante un mayor (33) impacto psicológico del COVID-19 desde el modelo de sistemas complejos . Tales síntomas centrales tienden a reforzar una mayor vulnerabilidad psicológica ante el contexto pandémico actual. ...
Network analysis of psychological distress, posttraumatic stress and fear symptoms by COVID-19 in Peruvian adults
Article
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Introduction: The coronavirus pandemic (COVID-19) and the social distancing measures used to mitigate the spread of the virus may have serious mental health consequences. Objective: To investigate the components network of the symptomatology of psychological distress, stress and fear of COVID-19 in Peruvian adults during the first pandemic wave in Peru during 2020. Methods: Six hundred nine Peruvian adults were includeds (57.51% women; M age: 27.04) from the Metropolitan city of Lima, who responded to the instruments adapted to Spanish: Impact of event scale-revised-R (IES-R), Patient Health Questionnaire-4 (PHQ-4) and Fear of COVID-19 Scale (FCV19S), whose item responses represented the network analysis with measures of centrality and stability of the nodes. Results: Higher measures of centrality were observed for the depressed mood, fear of contagion and fear of death items by COVID-19. The greatest network connections were found among depressive symptoms, post-traumatic avoidance symptoms, emotional symptoms of fear of COVID-19. Also, the stability of the strength centrality measures and the accuracy of the network nodes or variables was demonstrated. Conclusions: Participants manifested higher levels of symptoms of depression and fear of COVID-19, such symptoms were more central in the network, and reported higher activation connections in the network, the consideration of which is determinant for better effectiveness in pandemic intervention and prevention for health and behavioral sciences professionals Keywords: anxiety, depression, stress, fear, COVID-19, Coronavirus infections, psychological impact, mental health, post-traumatic stress disorders
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... El aislamiento social y la exposición repetida a la información sobre la COVID-19 en las noticias pueden estimular pensamientos obsesivos en algunas personas, lo que al final resulta en angustia psicológica y, en casos graves, trastornos mentales 6 . Los estudiantes universitarios son particularmente vulnerables a los problemas de salud mental y al pensamiento obsesivo sobre la COVID-19, ya que las estrictas medidas de distanciamiento social y los bloqueos dejaron a muchos estudiantes no solo inseguros sobre su salud, sino también sobre su posición académica y sus planes Asimismo, se ha encontrado relación entre la ansiedad miento informado de todos los participantes incluidos en el por la muerte y la obsesión 11,12 asociación con los síntomas de la obsesión, lo cual permite abrir una vía de investigación en el ámbito psiquiátrico desde el modelo de los sistemas complejos 19 . Tales conexiones refuerzan posibles rutas de activación de ambas variables de impacto negativo por COVID-19. ...
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... La importancia de identificar aquellos componentes centrales en las redes de correlación es de interés en las ciencias de la salud, (12) por ejemplo, la presente investigación permite orientar a los profesionales de enfermería a una mejor comprensión de la patogenia comórbida del impacto psicológico negativo de la COVID-19 para mejorar la atención integral de la salud mental desde una perspectiva de los sistemas dinámicos complejos. (21) Es posible elaborar intervenciones clínicas a partir de aquellos indicadores más prevalentes de la red que afectan a los hábitos alimenticios saludables y generan un mayor riesgo a desarrollar un trastorno de la conducta alimentaria ante la situación pandémica de la COVID-19 en adultos peruanos. Por lo tanto, la importancia de este método dinámico es primordial en la planificación y desarrollo de programas de tratamiento y terapia más eficaces. ...
Red de síntomas psicopatológicos de la conducta alimentaria, depresión, ansiedad y estrés postraumático en adultos peruanos en cuarentena por COVID-19
Article
Full-text available
  • Mar 2021
Introducción: Durante la cuarentena pueden alterarse los patrones de alimentación ante la ausencia de rutinas claras y marcadores de tiempo y espacio, además, la falta de actividad física provoca síntomas de ansiedad, miedo, estrés y depresión que afectan la calidad del sueño y favorecen el desarrollo de un trastorno de conducta alimentaria. Objetivo: Explorar las redes de correlación de síntomas psicopatológicos de la conducta alimentaria, depresión, ansiedad, y estrés postraumático en adultos peruanos en cuarentena por COVID-19. Métodos: Estudio exploratorio, correlacional, transversal, desarrollado en Lima, Perú, en junio de 2020. Se estudiaron a 490 adultos mediante encuestas online a partir del muestreo bola de nieve, se aplicaron tres medidas de autoinforme de salud: Impact of event scale-6, Patient Health Questionnaire-4 (PHQ-4) y Eating Disorder Examination–Questionnaire-7 (EDE-Q7). Se evaluaron mediante un modelo gráfico gaussiano de correlaciones parciales a través del paquete estadístico qgraph. Resultados: Los reactivos que reportan mayor magnitud de asociación son: PH1 “nerviosismo”, PH2 “animo deprimido”, PH3 “sobrepreocupación”, ED6 “insatisfacción sobre el peso”, ED7 “insatisfacción con la figura corporal”, ED1 “restricción por comer”, IE5 “evitación de pensamientos intrusivos por la COVID19”, y IE6 “dificultad de concentración por la COVID-19”. Conclusiones: La insatisfacción con el peso y estado de nerviosismo o ansiedad fueron los síntomas centrales en esta red. Los reactivos hipervigilancia, problemas de concentración, depresión, anhedonia y sobrevaloración del peso tuvieron relación directa con la insatisfacción con el peso y la ansiedad. La insatisfacción con el peso presentó más conexiones comórbidas en la estructura de la red.
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Estructura e invarianza factorial de una escala de perfeccionismo infantil adaptada para adolescentes
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Full-text available
  • Aug 2021
El objetivo de la investigación consistió en obtener las propiedades psicométricas de la adaptación para adolescentes de la escala de perfeccionismo infantil de Oros (2003) en 917 adolescentes peruanos, comprendido entre 13 y 18 años (M = 15.241, DT = 1.020). Mediante análisis factorial confirmatorio, se evidenció mejor parsimonia en el modelo de tres factores con óptimos índices de ajuste (S-Bχ2/gl = 0.51; CFI = .95, SRMR = .056, RMSEA [IC 90%] = .055 [.049-.061]). También se evaluó equivalencia de medida según sexo. Se proporciona evidencia de fiabilidad y validez convergente con la medida del Reynold Adolescent Depression Scale mediante la correlación de Pearson y análisis de red.
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Post-traumatic growth during the COVID-19 pandemic
Article
Full-text available
  • Aug 2021
In the traditional Japanese art of kintsugi, artisans fill the cracks in broken pottery with gold or silver, transforming the damaged pieces into something more beautiful than when they were new. damaged pieces into something more beautiful than they were when new. Post-traumatic growth (PTG) is like kintsugi for the mind. the mind, developed in the 1990s by psychologists Tedeschi & Calhoun Post-traumatic growth theory suggests that people can emerge from trauma or adversity having achieved positive personal growth. This theory is valid at a time times when we are living through this pandemic, which is changing the lives of people all over the world . Growing out of trauma is not unusual and studies support the notion that PTG is common and universal across cultures and in diverse age groups such as youth and adolescents. PTG generates a transformation and challenge in people's fundamental beliefs that leads them to be different from what they were before. The pandemic of COVID-19 may have the ingredients for fostering psychological growth. We are still in the midst of this situation, and we don't yet know what may happen, but it will have serious challenges in our lives. Although the effects may be devastating, it is possible to come out of this adversity with positive consequences. For some people, this event may be a shock to their core belief system, which reinforces the re-evaluation, reconstruction of psychological and philosophical beliefs and a life approach favorable to their personal growth. When looking at how people respond to traumatic events, PTG seems to be quite common, it is not something mental health professionals can prescribe or create, but they can facilitate it. It is considered a natural tendency that should be taken into account and encouraged, without trying to make people feel pressured or failures if they do not achieve this growth. The PTG framework is an integrated approach that includes elements of cognitive-behavioral therapy, along with other aspects that emphasize personal growth. It also has elements of narrative and existential aspects, because traumas often raise existential questions for people about what is important in life, being essential during the COVID-19 pandemic. Most evidence-based trauma treatments provide a "personalized approach" to relieve stress and symptoms such as anxiety
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El análisis de redes en la investigación clínica
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el análisis de redes ofrece una valiosa contribuciónmetodológica y práctica a la investigación médica, lo cual es útil paraque los profesionales clínicos interpreten y analicen la informaciónderivada de sus investigaciones y esto se vea reflejado en una atenciónintegral; en otras palabras, este enfoque permite realizar unaintervención concreta a partir de los resultados obtenidos mediante elanálisis de sistemas de modelos complejos.23 Además, el uso de estosmodelos complejos brinda una mayor explicación del funcionamiento dediversas condiciones de salud ante al impacto de diversas enfermedadesy situaciones, como la pandemia por COVID-19, y de los mecanismosetiológicos que interactúan entre sí
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The dynamic characteristics of mental health in Peruvian adults during quarantine by COVID-19
Article
Full-text available
  • Apr 2021
Background: The current SARS-CoV-2 pandemic accounts for more than one million infections, and has caused the death, so far, more than 300,000 people. In addition, it has had a great psychological impact in the Latin American context. Objective: to describe the dynamic characteristics of mental health in Peruvian adults during the COVID-19 quarantine. Methods: descriptive study, which explored the dynamic characteristics graphically, using a mental health instrument applied (online) to 763 Peruvian adults. A network analysis was applied using the qgrap packages and the LASSO graph. Results: higher network centrality measures were observed in the items related to negative symptoms in mental hea lth, such as item 9 (feeling of unhappiness and depression) and item 10 (loss of confidence); as well as the greater p osi tive connection between items 3 (decision making and trust) and 4 (meaning of life); and the highest negative relationship between components 1 (concentration) and 5 (tension and anguish). Conclusion: the individuals participating in the study mainly manifested feelings of unhappiness, depression and loss of confidence, among other negative symptoms. The study of the impact of the COVID-19 pandemic on mental health acquires greater precision and scientific basis when applying methods such as network analysis
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La atención sanitaria a pacientes con multimorbilidad. La percepción de los profesionales
Article
Full-text available
  • Oct 2020
Resumen Objetivo Explorar las percepciones de los profesionales sanitarios sobre las características de la atención sanitaria a pacientes con multimorbilidad. Diseño Estudio cualitativo de trayectoria fenomenológica realizado entre enero y septiembre de 2015 mediante 3 entrevistas grupales (grupos de discusión) y 15 individuales. Emplazamiento Servicio Aragonés de Salud. Participantes Profesionales médicos y de enfermería del Servicio Aragonés de Salud pertenecientes a distintos servicios: Medicina Interna, Atención Primaria, Urgencias y Gestión. También se incluyó un farmacéutico. Métodos Se realizó un muestreo intencional no probabilístico que permitiese configurar las unidades muestrales buscando criterios de representatividad del discurso, permitiendo conocer e interpretar el fenómeno estudiado en profundidad, en sus diferentes visiones. Se entrevistó a profesionales sanitarios con perfiles diferentes que conociesen en profundidad la atención a pacientes con multimorbilidad. Las entrevistas fueron grabadas, transcritas literalmente e interpretadas, mediante el análisis social del discurso. Resultados Se identifica una cultura profesional orientada a la atención de enfermedades individuales, falta de coordinación entre especialidades, pacientes sometidos a numerosas prescripciones, Guías de Práctica Clínica y formación especialmente centradas en enfermedades individuales. Conclusiones Tanto la cultura profesional como la organización del sistema sanitario se encuentran orientadas a la atención de enfermedades individuales, lo que redunda en dificultades para ofrecer una atención más integral a los pacientes con multimorbilidad.
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Personomics: The Missing Link in the Evolution from Precision Medicine to Personalized Medicine
Article
Full-text available
  • Oct 2017
Clinical practice guidelines have been developed for many common conditions based on data from randomized controlled trials. When medicine is informed solely by clinical practice guidelines, however, the patient is not treated as an individual, but rather a member of a group. Precision medicine, as defined herein, characterizes unique biological characteristics of the individual or of specimens obtained from an individual to tailor diagnostics and therapeutics to a specific patient. These unique biological characteristics are defined by the tools of precision medicine: genomics, proteomics, metabolomics, epigenomics, pharmacogenomics, and other "-omics." Personalized medicine, as defined herein, uses additional information about the individual derived from knowing the patient as a person. These unique personal characteristics are defined by tools known as personomics which takes into account an individual's personality, preferences, values, goals, health beliefs, social support network, financial resources, and unique life circumstances that affect how and when a given health condition will manifest in that person and how that condition will respond to treatment. In this paradigm, precision medicine may be considered a necessary step in the evolution of medical care to personalized medicine, with personomics as the missing link.
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‘Multimorbidity’ as the manifestation of network disturbances
Article
Full-text available
  • Jul 2016
  • J EVAL CLIN PRACT
We argue that 'multimorbidity' is the manifestation of interconnected physiological network processes within an individual in his or her socio-cultural environment. Networks include genomic, metabolomic, proteomic, neuroendocrine, immune and mitochondrial bioenergetic elements, as well as social, environmental and health care networks. Stress systems and other physiological mechanisms create feedback loops that integrate and regulate internal networks within the individual. Minor (e.g. daily hassles) and major (e.g. trauma) stressful life experiences perturb internal and social networks resulting in physiological instability with changes ranging from improved resilience to unhealthy adaptation and 'clinical disease'. Understanding 'multimorbidity' as a complex adaptive systems response to biobehavioural and socio-environmental networks is essential. Thus, designing integrative care delivery approaches that more adequately address the underlying disease processes as the manifestation of a state of physiological dysregulation is essential. This framework can shape care delivery approaches to meet the individual's care needs in the context of his or her underlying illness experience. It recognizes 'multimorbidity' and its symptoms as the end product of complex physiological processes, namely, stress activation and mitochondrial energetics, and suggests new opportunities for treatment and prevention. The future of 'multimorbidity' management might become much more discerning by combining the balancing of physiological dysregulation with targeted personalized biotechnology interventions such as small molecule therapeutics targeting specific cellular components of the stress response, with community-embedded interventions that involve addressing psycho-socio-cultural impediments that would aim to strengthen personal/social resilience and enhance social capital.
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The impact of multimorbidity on adult physical and mental health in low- and middle-income countries: What does the study on global ageing and adult health (SAGE) reveal?
Article
Full-text available
  • Aug 2015
  • BMC MED
Background: Chronic diseases contribute a large share of disease burden in low- and middle-income countries (LMICs). Chronic diseases have a tendency to occur simultaneously and where there are two or more such conditions, this is termed as ‘multimorbidity’. Multimorbidity is associated with adverse health outcomes, but limited research has been undertaken in LMICs. Therefore, this study examines the prevalence and correlates of multimorbidity as well as the associations between multimorbidity and self-rated health, activities of daily living (ADLs), quality of life, and depression across six LMICs. Methods: Data was obtained from the WHO’s Study on global AGEing and adult health (SAGE) Wave-1 (2007/10). This was a cross-sectional population based survey performed in LMICs, namely China, Ghana, India, Mexico, Russia, and South Africa, including 42,236 adults aged 18 years and older. Multimorbidity was measured as the simultaneous presence of two or more of eight chronic conditions including angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, and vision impairment. Associations with four health outcomes were examined, namely ADL limitation, self-rated health, depression, and a quality of life index. Random-intercept multilevel regression models were used on pooled data from the six countries. Results: The prevalence of morbidity and multimorbidity was 54.2 % and 21.9 %, respectively, in the pooled sample of six countries. Russia had the highest prevalence of multimorbidity (34.7 %) whereas China had the lowest (20.3 %). The likelihood of multimorbidity was higher in older age groups and was lower in those with higher socioeconomic status. In the pooled sample, the prevalence of 1+ ADL limitation was 14 %, depression 5.7 %, self-rated poor health 11.6 %, and mean quality of life score was 54.4. Substantial cross-country variations were seen in the four health outcome measures. The prevalence of 1+ ADL limitation, poor self-rated health, and depression increased whereas quality of life declined markedly with an increase in number of diseases. Conclusions: Findings highlight the challenge of multimorbidity in LMICs, particularly among the lower socioeconomic groups, and the pressing need for reorientation of health care resources considering the distribution of multimorbidity and its adverse effect on health outcomes.
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Defining Comorbidity: Implications for Understanding Health and Health Services
Article
Full-text available
  • Jul 2009
  • ANN FAM MED
Comorbidity is associated with worse health outcomes, more complex clinical management, and increased health care costs. There is no agreement, however, on the meaning of the term, and related constructs, such as multimorbidity, morbidity burden, and patient complexity, are not well conceptualized. In this article, we review definitions of comorbidity and their relationship to related constructs. We show that the value of a given construct lies in its ability to explain a particular phenomenon of interest within the domains of (1) clinical care, (2) epidemiology, or (3) health services planning and financing. Mechanisms that may underlie the coexistence of 2 or more conditions in a patient (direct causation, associated risk factors, heterogeneity, independence) are examined, and the implications for clinical care considered. We conclude that the more precise use of constructs, as proposed in this article, would lead to improved research into the phenomenon of ill health in clinical care, epidemiology, and health services.
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Personomics
Article
  • Apr 2015
When Francis S. Collins, MD, PhD, director of the US National Institutes of Health, and Harold Varmus, MD, director of theUS National Cancer Institute, recently commented on President Barack Obama’s new Precision Medicine Initiative,¹ they highlighted the improvements in human health that could result from real-time measurements of blood glucose, blood pressure, and heart rhythm; from defining each individual’s unique genotypes, gut microbes, and peripheral blood immune cells; and from detecting circulating tumor cells or tumor DNA. There can be no doubt that if genomics, proteomics, pharmacogenomics, metabolomics, and epigenomics can be used to identify treatments that are uniquely tailored to the individual, the possibilities are almost unimaginable. However, an important element has been left out of the discussion. Individuals are not only distinguished by their biological variability; they also differ greatly in terms of how disease affects their lives. People have different personalities, resilience, and resources that influence how they will adapt to illness, so that the same disease can alter one individual’s personal and family life completely and not affect that of another person much at all. Diseases do not just affect individuals; they affect their families and friends, and their communities. As is true of biological variability, these important attributes of people have an impact on an individual’s susceptibility to disease, how that disease will reveal itself phenotypically, and the way that disease—and the individual with the disease—will respond to treatment. The influence of the unique circumstances of the person—the “personome”—is just as powerful as the impact of that individual’s genome, proteome, pharmacogenome, metabolome, and epigenome.
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  • Jan 2015
  • 888-889
  • R C Ziegelstein
  • Personomics
Ziegelstein RC. Personomics. JAMA Intern Med., 2015;175:888-9.