In the Era of Precision Medicine and Big Data, Who Is Normal?

[Michael Scally MD]

[OA] In the Era of Precision Medicine and Big Data, Who Is Normal?

The definition of “normal” values for common laboratory tests often governs the diagnosis, treatment, and overall management of tested individuals. Some test results may depend on demographic traits of the tested population including age, race, and sex.

Ideally, laboratory test results should be interpreted in reference to a population of “similar” “healthy” individuals. In many settings, however, it is unclear exactly who these individuals are.

How much population stratification and what criteria for healthy individuals are optimal?

In particular, with the evolution of medicine into fully personalized or “precision” medicine and the availability of large-scale data sets, there may be interest in trying to match each person to an increasingly granular normal reference population.

Is this precision feasible to obtain in reliable ways and will it improve practice?

Manrai AK, Patel CJ, Ioannidis JPA. In the Era of Precision Medicine and Big Data, Who Is Normal?. JAMA. Published online April 23, 2018. In the Era of Precision Medicine and Big Data, Who Is Normal?

 

[Old]

Define "healthy", lol. The +/- 2 sigma often used for lab ranges does not guarantee health.
There are the political biases. What was the basis for the downward change of 'healthy' total T ranges that occurred last year? Men's sperm is drying up as their bellies extend - sounds normal.
Then there is the belief that being a bodybuilder is dysmorphic, but being transgender isn't ??? - talk about the extreme of BDD!
If insurance companies define 'normal', then everyone not currently smashed in a car wreak is 'healthy' and should not be treated for 'elective' health measures such as trying to stay alive.
Since 50% of people will eventually have a form of cancer, seems cancer is normal and 'healthy' - why discriminate against people with cancer by labeling them unhealthy.

 

[Apexvallen]

An issue I have is lab ranges not being adjusted for age of the patient.

 

[ickyrica]

I have issue with anyone telling me what I may or may not be able to do to my body, regardless of intent or end result. Normal or not. Mother fuckers, my body my rules.

First rule - no hot sauce lol