Overdiagnosis

Rationale, aims and objectives:
The practicing doctor, and most obviously the primary care clinician who encounters the full complexity of patients, faces several fundamental but intrinsically related theoretical and practical challenges – strongly actualized by so-called medically unexplained symptoms (MUS) and multi-morbidity. Systems medicine, which is the emerging application of systems biology to medicine and a merger of molecular biomedicine, systems theory and mathematical modelling, has recently been proposed as a primary care-centered strategy for medicine that promises to meet these challenges. Sig- nificantly, it has been proposed to do so in a way that at first glance may seem compatible with humanistic medicine. More specifically, it is promoted as an integrative, holistic, personalized and patient-centered approach. In this article, we ask whether and to what extent systems medicine can provide a comprehensive conceptual account of and approach to the patient and the root causes of health problems that can be reconciled with the concept of the patient as a person, which is an essential theoretical element in humanistic medicine.
Methods:
We answer this question through a comparative analysis of the theories of primary care doctor Eric Cassell and systems biologist Denis Noble.
Results and conclusions:
We argue that, although systems biological concepts, notably Noble’s theory of biological relativity and downward causation, are highly relevant for understanding human beings and health problems, they are nevertheless insufficient in fully bridging the gap to humanistic medicine. Systems biologists are currently unable to con- ceptualize living wholes, and seem unable to account for meaning, value and symbolic interaction, which are central concepts in humanistic medicine, as constraints on human health. Accordingly, systems medicine as currently envisioned cannot be said to be inte- grative, holistic, personalized or patient-centered in a humanistic medical sense.

In the last decade, the public has become increasingly aware and concerned regarding their susceptibility to common conditions such as obesity and diabetes. Groups of scientists have founded initiatives that harness this desire to stay disease free and have developed public health projects using a large population base. This novel approach relies on a wide volunteer group of indi- viduals who allow themselves to be monitored and studied over a long time period (ranging from a few months to many years). Data based on gene sequencing, sleep cycles, diets, activities, and blood sample analyses are recorded on a regular basis. By following each volunteer participant, whether they progress to disease or remain healthy, scientists hope to find lifestyle char- acteristics and corresponding microbiomes or genes that are key to living well. Projects such as the 100K Wellness Project, Lake Nona Life Project, and Google’s Baseline Study have well- established participant groups and aim to use this information to benefit the greater public and/or to make a profit.
Because individuals vary greatly, both in biological com- position and lifestyle, data collected from a ranging pop- ulation may give scientists a more comprehensive data source. These data, in turn, are used to construct a per- sonalized lifestyle plan for customers of wellness compa- nies such as Arivale or similar company models. A cus- tomized consultant is assigned to the consumer and will potentially give advice based on monitored parameters.
Technology has built another level of data monitoring; as part of the Google Baseline Study, GoogleX has created contact lenses that constantly monitor glucose concen- trations and smart trackers that can alert users of im- minent heart attacks. Similar technologies such as Samsung’s Simband constantly record and transmit information to a larger database, all as part of mass health studies. This recording and transmission of in- formation, however, makes some users uncomfortable about the prospect of data leakage or other loss of privacy that may harm them.
Here, we explore this rapidly developing sector where technology and mass population testing crosses. We asked 4 experts to give their input on the development potential and perceived drawbacks of this industry.