© 1999 Robert A. Freitas Jr. All Rights Reserved.

Robert A. Freitas Jr., Nanomedicine, Volume I: Basic Capabilities, Landes Bioscience, Georgetown, TX, 1999

1.2.4.2 Customized Diagnosis and Therapeutics

In science the objective is to understand the individual occurrence by means of a general law; in medical practice, knowledge of what is generally the case does not tell the physician how to treat a particular patient. Thus the problem of how to proceed from the prototypic case to the individual instance remains to be solved in a systematic manner by the practitioner.²²³⁰

The practitioner of "bedside medicine" in the 17th and 18th centuries had few curative and almost no customized tools at his disposal -- perhaps a few dozen basic surgical techniques, performed septically, hazardously, and without anesthesia, and a drug/herbal formulary consisting of a few hundred substances. For instance, the Edinburgh Pharmacopoeia of 1803 listed only 222 simples while the London Pharmacopoeia of 1809 listed fewer than 200 items, most of which had variable, uncertain, minimal, or nonspecific potency. A few more options became available to the 19th century medical practitioner, including complex surgical techniques for specific conditions that could be performed aseptically with anesthesia and a good chance for success, a somewhat broader and more efficacious pharmacopeia, vaccines targeted to several diseases, and an improving diagnostic ability. By the 20th century, the physician could prescribe from among tens of thousands of specific drugs to target specific bacterial, viral, fungal, or parasitic infections; select from among a very precise array of anesthetic agents, chosen to avoid allergic responses in particular patients; perform a wide variety of noninvasive tests and scans for diagnostic purposes to identify very specific conditions; and perform minimally invasive surgeries directed at many arbitrary tissue masses as small as 1 mm³ in volume. The first glimmerings of personalized genetic therapies also began to appear.

With the arrival of nanomedicine in the 21st century, the treatment paradigm will complete its transition from coarse-grained, one-size-fits-all, slow-acting methods to molecularly-precise, completely customized, speedy and highly-efficacious procedures and instrumentalities. The irregular shotgun pattern of 18th century palliatives will evolve during the early 21st century into a penetrating and perfectly tailored hail of "magic bullets" each targeting an individual cell or group of cells unique to the individual patient. The 19th century herbalist John Ayrton Paris could have been describing the nanomedical future in his popular textbook Pharmacologia, 1840 edition, when he wrote:

"If [a physician] prescribes upon truly scientific principles, he will rarely in the course of his practice compose two formulae that shall, in every respect, be perfectly similar, for the plain reason that he will never meet with two cases exactly alike. Now let me ask what constitutes the essential difference between the true physician and his counterfeit between the philosopher and the empiric? Simply this that the latter exhibits the same medicine in every disease, however widely each may differ from the other in its symptoms and character; while the former examines, in the spirit of philosophic analysis, all the existing peculiarities of his patient, and of his discord...and then adapts with a sound discretion and with a correct judgement of his medicinal agents, such means as may best be calculated to control and correct the patient's morbid condition."

Last updated on 5 February 2003