Los programas de medicina de precisión y los desafíos para la gestión de la salud pública

Autores/as

DOI:

https://doi.org/10.20983/epd.2023.77.1

Palabras clave:

Medicina de precisión, Inteligencia artificial, Farmacogenómica, Tendencias socioeconómicas

Resumen

Varios países iniciaron programas para el desarrollo de medicina de precisión. Con miles o millones de datos de salud, priorizando los mapas genéticos, mediante inteligencia artificial se elaboran algoritmos que identifican subpoblaciones con susceptibilidad a determinadas enfermedades para luego establecer la correspondencia farmacogenómica con las medicinas adecuadas. Este artículo realiza una acotada caracterización de esta propuesta y sistematiza aspectos críticos para su implementación desde una perspectiva de salud pública. Dados los argumentos expuestos, resulta probable que la medicina personalizada lleve a una mayor desigualdad entre países y regiones y al interior de los diferentes sectores sociales.

Biografía del autor/a

Guillermo Foladori, Universidad Autónoma de Zacatecas

Adscrito a la Unidad Académica en Estudios del Desarrollo de la Universidad Autónoma de Zacatecas (México). Miembro del Sistema Nacional de Investigadores del Conahcyt, nivel 3. Áreas de investigación: Ciencia, tecnología y sociedad.

Ericka Bracamonte-Aramburo, Universidad de Sonora

Adscrita al Departamento de Agricultura y Ganadería, Universidad de Sonora (México). Áreas de investigación: Medicina genómica y nanomedicina.

Citas

Afantitis, Antreas. 2020. “Nanoinformatics: Artificial Intelligence and Nanotechnology in the New Decade.” Combinatorial Chemistry & High Throughput Screening 23 (1).

Bosetti, Rita. 2015. “Cost-Effectiveness of Nanomedicine: The Path to a Future Successful and Dominant Market?” Nanomedicine (London, England) 10 (12): 1851–53. https://doi.org/10.2217/nnm.15.74.

Buisan Espeleta, Lydia. 1996. “Bioética y Principios Básicos de Ética Médica.” In Materiales de Bioética y Derecho, edited by María Casado, 1. ed, 108–22. Textos Abiertos. Barcelona: Cedecs Editorial.

Carchedi, Guglielmo. 2022. “The Ontology and Social Dimension of Knowledge: The Internet Quanta Time.” International Critical Thought 0 (0): 1–30. https://doi.org/10.1080/21598282.2022.2113170.

CDC. 2020. “Antibiotic-Resistant Germs: New Threats.” Centers for Disease Control and Prevention. March 13, 2020. https://www.cdc.gov/drugresistance/biggest-threats.html.

Cutler, David M. 2020. “Early Returns From the Era of Precision Medicine.” JAMA 323 (2): 109–10. https://doi.org/10.1001/jama.2019.20659.

Data Journalism Team. 2022. “Revealed: Pharma Leaders in Precision and Personalised Medicine.” Pharmaceutical Technology. January 25, 2022. https://www.pharmaceutical-technology.com/features/revealed-pharma-leaders-in-precision-and-personalised-medicine/#:~:text=According%20to%20our%20analysis%2C%20Novartis,from%20investments%20in%20precision%20and.

De Klerk, Geert Jan M. 1979. “Mechanism and Vitalism. A History of the Controversy.” Acta Biotheoretica 28 (1): 1–10. https://doi.org/10.1007/BF00054676.

Deloitte. 2017. “Pharma and the Connected Patient How Digital Technology Is Enabling Patient Centricity.” Deloitte Centre for Health Solutions. 2017. https://www2.deloitte.com/content/dam/Deloitte/uk/Documents/life-sciences-health-care/deloitte-uk-pharma-and-the-connected-patient.pdf.

EAPM. 2012. “European Alliance for Personalised Medicine.” 2012. https://www.euapm.eu/.

Farmer, P. 1996. “Social Inequalities and Emerging Infectious Diseases.” Emerging Infectious Diseases 2 (4): 259–69. https://doi.org/10.3201/eid0204.960402.

Federspil, Giovanni, and Nicola Sicolob. 1994. “The Nature of Life in the History of Medical and PhilosophicThinking.” Am J Nephrol 14 (4–6): 337–43.

Fornaguera, Cristina, and Maria José García-Celma. 2017. “Personalized Nanomedicine: A Revolution at the Nanoscale.” Journal of Personalized Medicine 7 (4): 12. https://doi.org/10.3390/jpm7040012.

FutureProofing Healthcare. 2021. “Índice de Medicina Personalizada de América Latina.” FutureProofing Healthcare. 2021. https://www.futureproofinghealthcare.com/es/mexico-indice-de-medicina-personalizada.

Galea, Sandro. 2016. “Precision Medicine and Population Health: Forging a Consensus.” BU School of Public Health. https://www.bu.edu/sph/news/articles/2016/precision-medicine-and-population-health-forging-a-consensus/.

García de Jesus, Erin. 2022. “How One Scientist Aims to Include More Black People in Genetic Data.” Science News, February 9, 2022. https://www.sciencenews.org/article/genetic-data-represent-black-people-tshaka-cunningham.

Geiser, Ken. 2015. Chemicals without Harm: Policies for a Sustainable World. 1 edition. Cambridge, Massachusetts: The MIT Press.

Gibson, Jennifer. 2021. “Death by Data: Drones, Kill Lists and Algorithms.” E-International Relations (blog). February 18, 2021. https://www.e-ir.info/2021/02/18/death-by-data-drones-kill-lists-and-algorithms/.

Herrmann, Inge K, and Matthias Rösslein. 2016. “Personalized Medicine: The Enabling Role of Nanotechnology.” Nanomedicine 11 (1): 1–3. https://doi.org/10.2217/nnm.15.152.

Hirschler, Ben. 2018. “Big Pharma, Big Data: Why Drugmakers Want Your Health Records.” Reuters, March 1, 2018, sec. Healthcare & Pharma. https://www.reuters.com/article/us-pharmaceuticals-data-idUSKCN1GD4MM.

Hunter, Philip. 2016. “The Big Health Data Sale.” EMBO Reports 17 (8): 1103–5. https://doi.org/10.15252/embr.201642917.

Inf. Belmont. 1979. “Informe Belmont.” Observatori Di Bioètica i Dret. April 18, 1979. http://www.bioeticayderecho.ub.edu/archivos/norm/InformeBelmont.pdf.

Iriart, Celia, Howard Waitzkin, Jaime Breilh, Alfredo Estrada, and Merhy Emerson. 2002. “Medicina Social Latinoamericana: Aportes y Desafíos.” Revista Latinoamericana de Salud Pública 12 (2): 128–36.

Iriart, Jorge Alberto Bernstein. 2019. “Precision Medicine/Personalized Medicine: A Critical Analysis of Movements in the Transformation of Biomedicine in the Early 21st Century.” Cadernos De Saude Publica 35 (3): e00153118. https://doi.org/10.1590/0102-311X00153118.

Klein, Kevin, Gerrit Borchard, Vinod P. Shah, Beat Flühmann, Scott E. McNeil, and Jon S. B. de Vlieger. 2021. “A Pragmatic Regulatory Approach for Complex Generics through the U.S. FDA 505(j) or 505(b)(2) Approval Pathways.” Annals of the New York Academy of Sciences 1502 (1): 5–13. https://doi.org/10.1111/nyas.14662.

Kling, Jim. 2007. “Diagnosis or Drug? Will Pharmaceutical Companies or Diagnostics Manufacturers Earn More from Personalized Medicine?” EMBO Reports 8 (10): 903–6. https://doi.org/10.1038/sj.embor.7401080.

Konski, Antoinette. 2022. “Personalized Medicine: 2021 FDA Guideposts for Progress.” The National Law Review. Foley & Lardner LLP, April 26, 2022. https://www.natlawreview.com/article/personalized-medicine-2021-fda-guideposts-progress.

Kwame Sundaram, Kwama, and Anis Chowdhury. 2018. “Developing Countries Losing Out To Digital Giants.” InterPress Service, October 17, 2018. https://www.globalissues.org/news/2018/10/17/24603.

Ledford, Heidi. 2019. “Millions of Black People Affected by Racial Bias in Health-Care Algorithms.” Nature 574 (7780): 608–9. https://doi.org/10.1038/d41586-019-03228-6.

Little, Stephen. 2005. “Personalised Medicine: What’s in It for Big Pharma?” Drug Delivery World (DDW). winter 2005. https://www.ddw-online.com/personalised-medicine-whats-in-it-for-big-pharma-1224-200512/.

Marcum, James A. 2008. An Introductory Philosophy of Medicine: Humanizing Modern Medicine. Springer. https://b-ok.org/book/740600/fbffed.

McQuillan, Dan. 2018. “Manifesto on Algorithmic Humanitarianism.” Presented at the symposium on ‘Reimagining Digital Humanitarianism’, University of London, February 16.

Microsoft Azure. 2015. “Los clientes de salud en la región pueden saltar a un TI moderno y a una mejor atención.” News Center Latinoamérica. August 18, 2015. https://news.microsoft.com/es-xl/los-clientes-de-salud-en-la-region-pueden-saltar-a-un-ti-moderno-y-a-una-mejor-atencion/.

Microsoft /Azure. n.d. “Precision Medicine Pipeline with Genomics - Azure Example Scenarios.” Microsoft Azure. Accessed October 20, 2022. https://learn.microsoft.com/en-us/azure/architecture/example-scenario/precision-medicine/genomic-analysis-reporting.

Mittelman, James H. 2022. “The Power of Algorithmic Capitalism.” International Critical Thought. https://doi.org/10.1080/21598282.2022.2070858.

National Institutes of Health. 2015. “Precision Medicine Initiative: Privacy and Trust Principles.” All of Us Research Program | NIH. 2015. https://allofus.nih.gov/protecting-data-and-privacy/precision-medicine-initiative-privacy-and-trust-principles.

Newsweek Vantage. 2019. “Precision Medicine: Creating Value for Everyone.” Newsweek and Think Big Partners WLL, 2019. https://d.newsweek.com/en/file/459604/newsweek-vantage-precision-medicine.pdf.

NHGRI. 2021. “The Cost of Sequencing a Human Genome.” National Human Genome Research Institute, NIH. 2021. https://www.genome.gov/about-genomics/fact-sheets/Sequencing-Human-Genome-cost.

Nicholson Price II, W. 2019. “Risks and Remedies for Artificial Intelligence in Health Care.” Brookings (blog). November 14, 2019. https://www.brookings.edu/research/risks-and-remedies-for-artificial-intelligence-in-health-care/.

Oguike, Osondu. 2021. A First Course in Artificial Intelligence. Sharjah: Bentham Science Publishers.

Parexel. n.d. “Precision Medicine Clinical Trials: A Personalized Approach to Medicine.” EIU Parexel. Accessed April 28, 2022. https://druginnovation.eiu.com/precision-medicine-trials/.

Pasquale, Frank. 2015. The Black Box Society: The Secret Algorithms That Control Money and Information. Cambridge: Harvard University Press.

Pasquinelli, Matteo. 2017. “Machines That Morph Logic: Neural Networks and the Distorted Automation of Intelligence as Statistical Inference.” Glass Bead Site1: Logic Gate. (The Politics of Artifactual Mind). https://www.glass-bead.org/article/machines-that-morph-logic/.

———. 2019. “How a Machine Learns and Fails. A Grammar of Error for Artificial Intelligence.” Spheres. Journal for Digital, no. ·5 Spectres of AI: 1–17.

Patseer. n.d. “Patent Landscape Report on Precision Medicine.” PatSeer. Accessed May 7, 2022. https://patseer.com/2020/12/patent-landscape-report-on-precision-medicine/.

Peirce, Charles Sanders. 1958. “Terms, Propositions, and Arguments. CP 2.95.” In The Collected Papers of Charles Sanders Peirce. Vol. 1931-1935. Vols. VII-VIII. Harvard University Press.

Pollet, Mathieu. 2021. “French Decision to Have Microsoft Host Health Data Hub Still Attracts Criticism.” Www.Euractiv.Com. February 19, 2021. https://www.euractiv.com/section/health-consumers/news/french-decision-to-have-microsoft-host-health-data-hub-still-attracts-criticism/.

Schork, Nicholas J. 2015. “Personalized Medicine: Time for One-Person Trials.” Nature 520 (7549): 609–11. https://doi.org/10.1038/520609a.

Statista. 2022. “Global Cloud Infrastructure Market Share 2022.” Statista. 2022. https://www.statista.com/statistics/967365/worldwide-cloud-infrastructure-services-market-share-vendor/.

Stoykova, Zhaklin, and Lyubomira Koeva-Dimitrova. 2019. “Personalized Medicine from Ancient Times to the Present [Възникване и Развитие На Персонализираната Медицина].” Health Economics and Management 1 (71): 10–20. https://doi.org/10.14748/ssvs.v2i0.4598.

Tauber, Alfred I, and Sahotra Sarkar. 1993. “The Ideology of the Human Genome Project.” Journal of the Royal Society of Medicine 86 (Sept): 537–40.

The Economist. 2020. “Doing Well? Fulfilling the Promise of Precision Medicine.” The Economist Intelligence Unit Ltd. https://www.eiu.com/n/fulfilling-the-promise-of-precision-medicine/#:~:text=Precision%20medicine%20is%20expected%20to,for%20money%3B%20and%20the%20overall.

UNODA. n.d. “The Convention on Certain Conventional Weapons.” United Nations Office of Disarmament Affairs. Accessed October 20, 2022. https://www.un.org/disarmament/the-convention-on-certain-conventional-weapons/.

Weiss, Kenneth M. 2017. “Is Precision Medicine Possible?” Issues in Science and Technology 4 (1). https://issues.org/is-precision-medicine-possible/.

Wetsman, Nicole. 2021. “Hospitals Are Selling Treasure Troves of Medical Data — What Could Go Wrong?” The Verge. June 23, 2021. https://www.theverge.com/2021/6/23/22547397/medical-records-health-data-hospitals-research.

World Economic Forum. 2020. “Global Precision Medicine Council Vision Statement 2020.” WEF. https://www3.weforum.org/docs/WEF_Global_Precision_Medicine_Council_Vision_Statement_2020.pdf.

World Health Organization. 2021. Ethics and Governance of Artificial Intelligence for Health: WHO Guidance. Geneva: World Health

Organization. https://apps.who.int/iris/handle/10665/341996.

Yuan, Bing. 2016. “Precision Medicine: Towards Complexity Science Age.” Chinese Journal of Integrative Medicine 22 (4): 251–57. https://doi.org/10.1007/s11655-016-2496-z.

Zhang, Mary. 2022. “Microsoft Azure’s Data Center Locations: Regions and Availability Zones.” Dgtl Infra (blog). April 11, 2022. https://dgtlinfra.com/microsoft-azure-data-center-locations/.

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27-08-2023 — Actualizado el 08-11-2023