The Biological and Biographical Basis of Precision Medicine

摘要

Construction of a patient narrative (case history) is a core strategy in the care of patients. Recent advances in biomarker identification and digital sensors to monitor physiological and behavioral features have made constructing a case history more complex. Notably, however, although a biological profile is increasingly a part of the patient's profile, an analogous patient-based biographical (life experience) profile is typically overlooked. Evolving concepts such as allostasis and allostatic load refer to processes promoting stability of physiological systems in the presence of diverse life experiences. Integrating details of both biology and biography is a goal of "precision medicine." In this review, we describe how complex interactions between biology and biography affect disease risk and treatment response and highlight a strategy to develop narratives that establish the integration of biology and biography as the scientific basis for precision medicine.