Precision Medicine

Definitions, scope and terminology

• Precision medicine — capitalises on knowledge of an individual's molecular, genomic, cellular, clinical, behavioural, physiological and environmental parameters to inform the prevention, diagnosis and treatment of disease; used interchangeably with personalized, stratified and individualized medicine.
• Operational mission — the discipline of delivering the right drug, at the right dose, to the right patient, at the right time — the primary mission of the clinical pharmacologist; the "right time" spans both the sequence of therapies and temporal control of exposure.
• Pharmacogenomics is the basis — PGx forms the basis of precision medicine (genetic information to select the right drug and dose), but the framework is broader — it operationalises PGx plus biomarkers, multi-omics, companion diagnostics, real-world evidence, digital tools and trial design into routine prescribing.
• Boundary with pharmacogenetics — pharmacogenetics / pharmacogenomics is the mechanistic study of DNA/RNA variation as related to drug response; precision medicine is the downstream clinical framework that operationalises it — broader than, and downstream of, the sibling mechanistic topic.
• Stratification and P4 medicine — the conceptual engine is stratification — replacing one-size-fits-all / average-patient prescribing with therapy tailored to a molecularly or phenotypically defined subgroup (or individual); aspirationally framed as P4 medicine — predictive, preventive, personalized, participatory, favouring a pre-emptive rather than reactive posture.