Precision medicine and the problem of structural injustice.

IF 2.3 2区 哲学 Q1 ETHICS
Medicine Health Care and Philosophy Pub Date : 2023-09-01 Epub Date: 2023-05-25 DOI:10.1007/s11019-023-10158-8
Sara Green, Barbara Prainsack, Maya Sabatello
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引用次数: 0

Abstract

Many countries currently invest in technologies and data infrastructures to foster precision medicine (PM), which is hoped to better tailor disease treatment and prevention to individual patients. But who can expect to benefit from PM? The answer depends not only on scientific developments but also on the willingness to address the problem of structural injustice. One important step is to confront the problem of underrepresentation of certain populations in PM cohorts via improved research inclusivity. Yet, we argue that the perspective needs to be broadened because the (in)equitable effects of PM are also strongly contingent on wider structural factors and prioritization of healthcare strategies and resources. When (and before) implementing PM, it is crucial to attend to how the organisation of healthcare systems influences who will benefit, as well as whether PM may present challenges for a solidaristic sharing of costs and risks. We discuss these issues through a comparative lens of healthcare models and PM-initiatives in the United States, Austria, and Denmark. The analysis draws attention to how PM hinges on-and simultaneously affects-access to healthcare services, public trust in data handling, and prioritization of healthcare resources. Finally, we provide suggestions for how to mitigate foreseeable negative effects.

精准医疗与结构性不公正问题。
目前,许多国家都在投资技术和数据基础设施,以促进精准医疗(PM)的发展,希望通过精准医疗更好地为患者量身定制疾病治疗和预防方案。但谁能从精准医疗中受益呢?答案不仅取决于科学发展,还取决于解决结构性不公正问题的意愿。重要的一步是通过提高研究的包容性来解决某些人群在 PM 队列中代表性不足的问题。然而,我们认为需要拓宽视角,因为预防疟疾的(不)公平效果也在很大程度上取决于更广泛的结构性因素以及医疗保健战略和资源的优先次序。在实施 PM 时(以及在实施 PM 之前),关注医疗保健系统的组织结构如何影响受益者,以及 PM 是否会对团结一致分担成本和风险带来挑战,都是至关重要的。我们通过对美国、奥地利和丹麦的医疗保健模式和 PM 计划的比较来讨论这些问题。通过分析,我们注意到 PM 如何影响并同时影响医疗服务的获取、公众对数据处理的信任以及医疗资源的优先排序。最后,我们就如何减轻可预见的负面影响提出了建议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.30
自引率
4.80%
发文量
64
期刊介绍: Medicine, Health Care and Philosophy: A European Journal is the official journal of the European Society for Philosophy of Medicine and Health Care. It provides a forum for international exchange of research data, theories, reports and opinions in bioethics and philosophy of medicine. The journal promotes interdisciplinary studies, and stimulates philosophical analysis centered on a common object of reflection: health care, the human effort to deal with disease, illness, death as well as health, well-being and life. Particular attention is paid to developing contributions from all European countries, and to making accessible scientific work and reports on the practice of health care ethics, from all nations, cultures and language areas in Europe.
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