Motivation

Science is a beautiful way to learn about the world including our own body. Scientific research results in powerful instruments for healing. Science also objectifies: the "I" disappears, both my own "I" and the "I" (the self, the unique part) of what or of whom is being studied. As a scientist I feel oppressed by this: the facts that I investigate, no matter how fascinating and possibly useful they may be, ultimately are just that, facts — and the joy of life is not to be found there.

My research area is pharmacy: developing new medicinal drugs. We objectify, we try to find the largest common denominator, the disease characteristic that holds for all patients and that we can influence by a pill or injection. In this process the individual person disappears from sight. People differ from one another. We, the scientists, think these differences are a nuisance. People experience all kinds of feelings, and have diverse complaints while suffering from the same disease. We would like to reduce everything to an objective measure, such as the concentration of a specific protein in the blood. Also, people may heal "spontaneously", the well-known placebo effect. For us this is a complication, because it makes it more difficult to ascertain how effective a new drug is compared to doing "nothing".

Personalized medicine is a new buzz-word in the pharmaceutical industry. No longer one medication for each patient suffering from disease X, but a treatment that is fine-tuned to genetic and other characteristics of the person. Many people, including me, suspect that this is the only way to develop medicinal drugs in the future. As we learn more about the biology of complex afflictions such as cancer, cardiovascular diseases and arthritis, we also learn that no uniform explanation exists for each of these diseases, that manifestations and causes differ between individuals, and that nutrition, behavior and beliefs can have large effects on disease initiation and progression.

What does this imply for personalized medicine? Are we going to attempt to collect more and more objective data and analyze these with advanced computer models, from which medication and lifestyle rules will be derived? Will we perform full genetic and biochemical screening of individuals, in order to predict in an objective manner their health risks and treatment options on the basis of the best statistical models and large, comparative datasets obtained by screening thousands of people? The first experiments with personal counseling on the basis of individual DNA profiles are already ongoing.

Is this an attractive outlook? It is very high-tech, very modern, but also extremely non-transparent to the average lay person. The individual's own body changes into an objectified composition of cells and molecules, of which the computer proclaims what should be done to keep it in optimal shape. How are we going to deal with all uncertainties of the computer models, with the still unknown relationships, and with connections for which the data are still scarce? Will it be necessary for doctor and patient to choose from ten different possibilities that are difficult to weigh against one another? This may seem a very distant and long-term perspective. But one can hardly be mistaken to see medical science developing toward ever more complex diagnostics based on statistical interpretation of protein levels, metabolite concentrations, gene expression etc.

The possibilities stemming from this development are fantastic. The big challenge in my opinion is to exploit these possibilities in such a way that meaningful choices result for people. How can we ensure that the emerging technology does not lead to a subtle suppression of the expression and experiencing of individuality, as the consequence of a transferal of decisions to an external diagnosis and treatment system? Can we use the new possibilities on the contrary to promote freedom and individuality, and can we guarantee that access to those possibilities is not limited to the most affluent and best informed people?

For me personal health is about doing justice to the unity of body, soul and mind that is unmistakenly human. It seems to me that achieving that goal requires us to learn to reconnect the subjective and the objective.