The end of one-size-fits-all healthcare| Trending Viral hub

It has been known for decades that the vast majority of human biological differences do not occur between groups, but between people. It’s strange that scientists and doctors still resort to separating people into huge populations when trying to understand us: ethnicity, race, sex and gender. 2024 will mark the year in which they finally give up their reliance on these broad categories and begin to focus on the individual.

To give an example of how crude the population approach can be: Women are less likely to be diagnosed with heart attacks even when they experience typical heart attack symptoms, because people generally associate heart attacks with men. What matters in this and most other common conditions is not the sex of the patient, but the patient’s particular symptoms. Every woman (and man and non-binary person) is physiologically different from the rest. Flattened categories that focus on the statistically “typical” patient in each group do little justice to this complexity.

At times, the use of categories has been purely pseudoscientific, with devastating consequences. In 2021, the United States National Football League made the long-awaited decision to end its controversial use of “race rules”, which assumed that black players with brain damage had lower levels of cognitive function to begin with. As a result, black players were less likely to receive financial compensation for their injuries. The NFL’s action had repercussions on science and medicine. A compelling argument has already been made against the use of race-based equations when estimating kidney function, and many laboratories are now abandoning this practice.

In 2024, scientists will finally move toward understanding each person as a multifaceted individual. Achieving this level of granular detail may seem unattainable for health services and medical researchers dealing with millions of patients, but we have already entered an era where data collection and processing power offer the ability to do precisely that. Coupled with advances in personal genome analysis and information on physical activity, diet, stress, and hormonal and menstrual cycles potentially available through our own devices, researchers can know more than ever about individual patients.

For example, the community group founded by a family Patients like me, which launched in 2005, has brought together patients with complex conditions like infertility and lupus, giving them space to share their lived experiences in enormous detail. Not only can a patient see what treatments work for others, but they can also tell others what treatments work for them. This data, in turn, is used to inform health research. Headquartered in Cambridge, Massachusetts, the platform now has more than 850,000 members.

When any of us take a medication for the first time, it is vital to know that it is safe and effective for most people, but it is even more important to know that it will not harm us personally. At the University of Pennsylvania, David Lydon-Staley of the Addictions, Health and Adolescence Laboratory has been asking whether it would be possible to do trials where n=1. For a fortnight, he tested melatonin gummies on himself, almost as if he were in a clinical trial, to determine if they could help him sleep better. The goal was not to understand if the gummies worked for most people, but to find out if they worked for himthe person who needed them (by the way, in his case, he didn’t need them).

This is a maverick approach and may not fit well with the way modern clinical trials work, but it points towards a different kind of science of human difference. By moving from population-level studies to individual-level studies, in 2024 scientists will also begin to paint a more detailed portrait of who we are as a species. The challenge is how to do it safely, without compromising privacy, and how to include everyone on the planet, not just a few.

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