The following article first appeared in German in the June 2025 issue of Laborjournal and was translated with the help of ChatGPT

Personalized medicine – or, as it prefers to be called these days, precision medicine (PM) – has been heralded for some time now as a kind of salvation. The great leap forward on the path to a healthier, more satisfying, and longer life. PM sounds so good, who could be against it? So convincing that it seemingly no longer needs any further proof that it represents something genuinely new – the golden road to the future of medicine.

Because who would argue against a “more precise” or “more personalized” medicine? That would be like questioning safer roads or better weather. And that’s precisely why it’s remarkable how confidently science and politics showcase these terms to the public – and mobilize massive funding to support them. Even the coalition agreement of the new German government states its commitment: “We will strengthen health research with a focus on personalized medicine.” One might be tempted to ask: Cui bono?

When it comes to promises of salvation, PM is second only to artificial intelligence (AI), which has recently claimed the top spot in the world of biomedical hype. Both compete to be nothing less than the future of medicine.

AI and PM, prophets of a golden era in prevention, diagnostics, and therapy, have quite a bit in common: the hubris of their promises, few of which have materialized; the glossy marketing; a surprisingly long backstory; and a conspicuous lack of evidence that is conveniently overlooked.

Interestingly, the history of PM stretches much further back than that of AI – to the early 20th century, when the concepts of metabolism and genetics were just beginning to be understood. It was then that the idea of ‘chemical individuality’ was introduced, most notably by Archibald Garrod, who elaborated on it in *The Inborn Factors in Disease*. At that time, ‘factor’ was the common term for what we now call a gene.

The rather obvious influence of individual genetic and biochemical factors on disease progression (and therefore therapy) didn’t become the basis for a massive marketing campaign until the 1990s. That’s when the term ‘molecular medicine’ was coined—suggesting, what a surprise, that diseases could be understood at the molecular level.

[Not to be confused with ‘orthomolecular medicine’—an esoteric concept promoted by none other than Linus Pauling, winner of two Nobel Prizes. So much for the epistemic authority of Nobel laureates. Today, this idea lives on in every pharmacy aisle as shelves stocked with expensive but essentially useless placebo products from the company Orthomol.]

The academic concept of ‘molecular medicine’—nowadays still found in institute names, degree programs, or journal titles—was quickly overtaken linguistically by marketing forces. The term ‘personalized medicine’ was simply superior. Any country doctor can rightly claim to treat patients individually, but ‘personalized’ just sounds fresher and more appealing than ‘molecular’. The latter seems impersonal and technocratic—whereas we desire empathy from our doctors, a truly personal medicine.

This was nicely summed up by none other than Barack Obama: “Doctors have always known that each patient is unique—and they’ve always tried to tailor treatments as best they could. You can, for instance, match a blood transfusion to a blood type—that was a breakthrough discovery. But what if it were just as easy, just as routine, to match a cancer treatment to our genetic code? What if finding the right drug dosage were as simple as taking a temperature?” In 2015, the then-president announced the U.S. government’s billion-dollar Precision Medicine Initiative (PMI) with exactly these words—a statement that feels almost unimaginable in today’s Trumpian era.

Interestingly, the academic PR machinery in the U.S. had already moved a step further. ‘Personalized Medicine’ had evolved into ‘Precision Medicine’. A genius rebranding move. Because medicine, in some form, had always been personalized—and the term led many to believe it meant truly custom-fit treatments for each individual.

The effects of this so-called ‘personalization’ were, in any case, barely scientifically demonstrable. Proving it would require a slew of n=1 studies—no control group, no blinding, no randomization. In other words: pure anecdotes. Treatments where patients often improve anyway, wrongly attributing it to ‘personalization’ rather than—more accurately—to regression to the mean or simply the placebo effect (see also ‘Der Narr’ in LJ 1–2/2018). Or, as Voltaire aptly put it: “The art of medicine consists in amusing the patient while nature cures the disease.”

So, since Obama at the latest, the future of medicine belongs to precision! In Germany, however, this subtle shift in terminology hasn’t quite caught on. Many colleagues still speak of ‘personalized medicine’, even though the term is now outdated from a marketing perspective.

PM, we are told, takes into account individual differences in genes, environment, and lifestyle. That doesn’t sound all that groundbreaking—in fact, it’s so obvious that it should be considered banal and therefore self-evident. Of course, a bit of self-promotion is part of the game—we need funding for our research, and the pharmaceutical industry must keep its shareholders happy. But then why is ‘Der Narr’ so upset?

Because that’s where the problem lies: the overblown promise that this will prevent disease, cure illness, improve the lives of the sick—and even extend them. Supposedly, PM will deliver incredible effects. But this should be questioned, especially since there are far simpler and more effective ways to improve public health—provided the will is truly there. These would require no billion-dollar funding programs for biomedicine and no hefty profits for Big Pharma. And the promises of PM? Not only grossly exaggerated, but often scientifically untenable.

Less disease, substantial life extension with improved quality of life, all evidence-based, with massive effects—without more precise or personalized medicine, and right here, right now? How could that possibly work?

To begin with, there are the so-called avoidable treatment deaths. These are fatalities that could be prevented through timely and effective medical care—for example, early detection and treatment of cancer, care for heart attacks or strokes, and treatment of chronic illnesses (like diabetes)—all according to existing, standard medical knowledge. No need for PM, AI, or any other approach that only exists on paper.

I mean no offense, but smokers disqualify themselves as advocates of PM. Smoking—along with physical inactivity and poor diet—is a major risk factor for chronic diseases like cardiovascular issues, respiratory disorders, or cancer. Each year, an estimated 143,000 people in Germany die from smoking-related causes—globally, over 7.6 million. Roughly one in seven deaths (15%) are directly attributable to smoking, with another 2% due to passive smoking. Even modest reductions in smoking rates would have major health impacts.

Another example: high blood pressure is the leading risk factor for stroke and responsible for at least 10 million deaths globally each year. It’s easy to detect and inexpensive to treat. With basic tools and affordable medication, one could significantly increase life expectancy and years of healthy living.

Which brings us to health system structures. How much is invested in health education, screening, availability, and access to treatment? Comparisons between countries highlight just how much potential lies in improving these systems. Compare per-capita healthcare spending, life expectancy, morbidity rates, and QUALY-based efficiency indices across nations. The gaps are massive. South Korea, Spain, and Japan achieve high life expectancy, good elderly health, and relatively low system costs. It’s a completely different story in countries like Germany and the U.S., where the U.S. spends $5 trillion—or 17% of its GDP—on healthcare, yet life expectancy is 10 years shorter than in South Korea, which spends only a quarter as much per citizen.

And you don’t even need to travel far to see this potential. A glance at life expectancy differences within Germany is enough to raise eyebrows. For example, men in Baden-Württemberg live on average four years longer than those in Saxony. In Berlin, men in Steglitz-Zehlendorf live three years longer than those in nearby Lichtenberg, just 10 km away.

In the U.S., home of the Precision Medicine Initiative, the disparities are even more dramatic. In Chicago, riding the Red Line subway from one end to the other corresponds to a 30-year drop in life expectancy. Wouldn’t it make more sense to focus on these disparities before pouring millions of taxpayer dollars into the promised wonders of precision medicine? I find it cynical not to juxtapose PM and AI promises with reality.

This is not only about systemic differences but more fundamentally about socioeconomic structures—a euphemism for the fact that many people simply don’t earn enough to live healthily. What about health behaviors (smoking, alcohol, exercise), education, access to care (which clearly doesn’t function properly despite astronomical spending), income, working conditions, housing, and so forth? As Rudolf Virchow stated back in 1848: “Medicine is a social science, and politics is nothing more than medicine on a large scale.”

Why, then—aside from the Jester—does no one question the wisdom of investing in highly expensive, future-oriented, narrowly targeted, and likely marginal effects of “precision” or “personalized” medicine, instead of focusing on immediately implementable, causal, and highly effective measures?

Because such measures wouldn’t attract research funding and are of zero interest to the pharmaceutical industry. We are scientists and doctors—socioeconomic factors and healthcare systems aren’t our concern. Let someone else handle that.

But it *is* our concern. Precision medicine’s focus on rare diseases is no coincidence. These are often monogenic, making them ideal for gene therapy—the pinnacle of precision and personalization. Many countries incentivize the development of orphan drugs through tax breaks, research grants, fast-track approvals, and market exclusivity. Prices per patient can be astronomical—several hundred thousand euros per year is common.

PM seeks hyper-specialized solutions for small patient groups, while population-wide strategies (like vaccination programs or lifestyle prevention) are more cost-effective and reach more people. PM fragments healthcare and diverts resources into expensive tests and niche drugs. Clearly, this targets specific income groups.

There’s also the very limited medical benefit to date. Despite decades of genetic testing and biomarker identification, only a few biomarker-driven therapies have proven effective. Most diseases, especially complex ones like diabetes or Alzheimer’s, are not monogenic but multifactorial—shaped by genes, environment, and lifestyle.

All the talk about PM’s benefits to public health distracts from the fact that recent breakthroughs haven’t come from greater precision. Quite the opposite. Consider GLP-1 agonists—taken by over 10% of Americans—or mRNA technologies, which revolutionized vaccine development and may soon enter cancer therapy.

And let’s not forget cytochrome P450 enzymes (e.g., CYP2D6, CYP2C19, CYP3A4), key to drug metabolism. Genetic variants affect how drugs are processed—allowing for tailored therapy. This matters for antidepressants, clopidogrel, tamoxifen, and more. I learned this in medical school—decades ago. Yet, testing for CYP polymorphisms? Hardly ever done. Despite strong evidence, relevance to prescribing, and low cost, this flagship example of personalized medicine is rarely used.

Have I become a Luddite, ignoring PM’s triumphs—like CAR-T therapy? These involve extracting a patient’s T-cells, genetically modifying them to target their cancer, and reinfusing them. This is the essence of PM: the right therapy for the right patient at the right time—based on biology, not broad averages.

Yet CAR-T therapies, like other PM approaches, face problems: serious side effects, technical complexity, limited availability, and astronomical cost. Their efficacy is restricted to certain cancers, with long-term effects unclear.

CAR-T is a milestone in immunological research and life-saving for some patients in otherwise hopeless situations. That’s fantastic—it deserves funding and broader access. But it’s no example of how PM will transform public health—especially not globally.

The notion that precision or personalization is a panacea is little more than the fairly obvious conclusion: diseases are complex and vary between individuals. This isn’t news. Yes, we understand more today—but every day in the lab or clinic reminds us just how much more complex it is.

And as if intrinsic pathophysiology weren’t enough, we must also consider (epi)genetic, social, and environmental factors—as triggers, drivers, or modulators. These are hard to study in animal models, harder still in clinical settings, and they interact in different ways in each individual. Lifestyle, past illnesses, exposures, prior treatment quality, concurrent medications, adherence—the list goes on.

Precision medicine sounds elegant, fundable, visionary. If only it were marketed for what it is at best: positive PR for the humbling truth that medicine is complex, every case is different, and we need more research. That wouldn’t be particularly helpful—but it would be acceptable.

Instead, the dominant narrative—fueled by media and politics—is evidence-free: PM is ‘better’, keeps us healthier, extends life, and is cheaper than the supposedly crude and outdated ‘imprecise’ medicine. This story isn’t just naïve—it’s a convenient, interest-driven exaggeration.

It turns cynical when it obscures—or deliberately ignores—the fact that there are already more effective, simpler, and evidence-based ways to promote health and prolong life: fighting poverty, fair distribution of health resources, and universal access to quality basic care.

I am inevitably reminded of Pinocchio. With every overhyped promise, every premature press release about an ‘Alzheimer breakthrough’, every techno-utopia about AI or PM—the nose of modern medicine grows. Today’s tempters aren’t Fox and Cat, but funders, Big Pharma, media, and politicians.

The great trial, like in Collodi’s tale inside the belly of the whale, still awaits medicine: the trial of evidence—ultimately, of our entire biomedical research system’s effectiveness.

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