In contrast to Osler’s theorem – the “individuality” of disease – contemporary medical diagnostics and treatment of disease are largely based on principles of commonalities.

For example, all those presenting to their doctors with a particular combination of medical problems meeting the medical criteria for rheumatoid arthritis will be given this diagnosis and treated with the standard first-line medication.

"Our medical care needs to be more customized such that all opportunities to predict and mitigate risk for disease are optimized across the population."

A personalized approach

Since our health is integrally influenced by our genetic make-up, we are indeed individual in our response to disease, our reaction to its treatment and in the types of diseases we develop. As Osler’s words imply, we are not well served by a “one-size fits all” healthcare model.

Our medical care needs to be more customized such that all opportunities to predict and mitigate risk for disease are optimized across the population. Personalizing healthcare does not imply that each individual receive unique medical management but rather takes into account an individual’s genetic and other relevant characteristics to improve the efficacy of healthcare decisions.

Connecting the dots

This “personalized” approach, already successfully applied in a few areas of medicine, is illustrated by the use of Herceptin to treat breast cancer patients. Herceptin was designed to target a specific cancer gene mutation, HER2, found in some breast cancer patients.

While other examples of personalized healthcare are already in play, operationalizing this practice paradigm across the spectrum of medical care has until recently been impeded by the high costs inherent in obtaining a person’s complete genetic profile (a.k.a. “whole genome sequencing”).

Increasing accessibility

This barrier is now vanishing as a virtual freefall in gene sequencing costs has made determination of an individual’s whole genome sequence increasingly affordable and available.

While potentially transformative to the practice of medicine, connecting population-wide genome sequencing to personalized and more effective healthcare will be no small challenge.

As it happens so often in medicine, technology has radically outpaced the understanding of the knowledge it produces. The scientific and medical communities face a virtual tsunami of personal genetic information that is only in the early stages of interpretation.

As evidenced by the poor state of health informatics across this country, the healthcare system does not respond well to demands for rapid change.

But change it must.

The healthcare system needs to define its own VUCA: the Vision, Unity of purpose, Creativity and Agility that has driven the extraordinary advances in information and, for that matter, genetic technologies.


Only then can we deliver the personalized healthcare that Osler envisioned and Canadians deserve.