The medical practice termed Personalized Medicine ideally uses all the patient’s possible characteristics in predicting disease predisposition and response to therapy, but primarily employs the individual’s unique molecular make-up in the tailoring of treatment. This change in medical practice also entails an epistemic shift towards ‘molecularization’: individuals and disease are now understood and governed through life’s basic building blocks. In this paper we argue that underlying personalized medicine is a continued understanding of the pathological state as a quantitative deviation from a normal state. In this we build on the critique of French philosopher Georges Canguilhem who positioned the quantitative interpretation of the pathological in nineteenth century medical thinking. Personalized cancer medicine takes each patient’s cancer as singular, implying that there is no ‘normal’ baseline for comparing individual pathology. We analyze cases of personalized cancer clinical trials from recent years to show that each displays a quantitative understanding of the pathological reminiscent of past thinking in two main modes: a molecularized interpretation of cancer pathology and a quantitative measuring of targeted therapy efficacy. We situate the analysis in broader discussions of historical medical shifts and in current studies of personalized medicine, to outline implications of this form of continuity.

被称为“个性化医疗”的医疗实践理想地利用患者的所有可能特征来预测疾病倾向和对治疗的反应，但在定制治疗时主要利用个体独特的分子组成。医疗实践的这种变化也带来了向“分子化”的认识转变：现在可以通过生命的基本组成部分来理解和控制个体和疾病。在本文中，我们认为个性化医疗的基础是对病理状态作为与正常状态的定量偏差的持续理解。在此，我们以法国哲学家乔治·康吉扬 (Georges Canguilhem) 的批评为基础，他将病理学的定量解释置于十九世纪的医学思想中。个性化癌症医学将每个患者的癌症视为单一的，这意味着不存在用于比较个体病理学的“正常”基线。我们分析了近年来个性化癌症临床试验的案例，表明每个案例都以两种主要模式对病理学进行定量理解，让人想起过去的思维：癌症病理学的分子化解释和靶向治疗疗效的定量测量。我们将分析置于对历史医学变迁的更广泛讨论和当前个性化医疗研究中，以概述这种连续性形式的含义。