Biology, biography, and the translational gap.

Medicine-based evidence integrates a patient's biology and biography to improve individual medical care and to help eliminate the translational gap between research and the clinic.

The whole lupus: Articulating biosocial interplay in systemic lupus erythematosus epidemiology and population disparities.

Systemic lupus erythematosus (SLE), commonly known simply as lupus, is an autoimmune disease in which the body's immune system attacks healthy tissue and organs. Characteristic of the disease is a disproportionate effect on women and communities of color, both in terms of prevalence and severity of symptoms. Lupus is also both genetically driven and subject to external environmental conditions, many with place based corollaries. Thus, lupus presents a series of complex and intersecting biosocial questions regarding its origin and treatment, questions which transdisciplinary approaches are uniquely suited to address. In this paper, we propose a framework, incorporating critical approaches to the production of embodied formations of race and gender as well as new understandings of the impact of environmental conditions and lived experience at the genetic level, that can direct future research into lupus that is both more inclusive of a range of influences and more precise in its ability to treat and diagnose the disease.

Social Determinants of Treatment Response.

Socioeconomic status is consistently linked to population health and specifically to the finding that there is decreasing health associated with decreasing social position. Despite the substantial literature, an analogous literature that is focused on clinical practice, and especially consideration of the individual, is almost nonexistent. Even in the absence of these data, physicians routinely incorporate patient life experience (biography) into their estimation of a patient's clinical trajectory (prognosis) and when making therapeutic decisions. Some advances have occurred that strengthen the evidence base, such as the US Food and Drug Administration decision to show all results from randomized controlled trials on newly approved drugs by age, sex, and race. In this article we review the current status of research on the impact of social determinants of treatment response and illustrate the important role of the therapeutic context in both research and practice. Examples are provided in which a patient's "biography" alters treatment response in subgroups of the population studied. We also provide examples in which multi-omic data and biographical information in a single individual can illuminate the clinical expression of disease. Finally, we suggest a research agenda that would better support physicians who use social and behavioral features as important elements in their decision making in clinical care.

The fluidity of biosocial identity and the effects of place, space, and time.

Public and scientific conceptions of identity are changing alongside advances in biotechnology, with important relevance to health and medicine. In particular, biological identity, once predominantly conceived as static (e.g., related to DNA, dental records, fingerprints) is now being recognized as dynamic or fluid, mirroring contemporary understandings of psychological and social identity. The dynamism of biological identity comes from the individual body's unique relationship with the world surrounding it, and therefore may best be described as biosocial. This paper reviews advances in scientific understandings of identity and presents a model that contrasts prior static approaches to biological identity from more recent dynamically-relational ones. This emerging viewpoint is of broad significance to health and medicine, particularly as medicine recognizes the significance of biography - i.e. the multiple, dense interactions imparted on a body across spatio-temporal dimensions - to phenotypic prediction, especially disease risk.

From Evidence Based Medicine to Medicine Based Evidence.

Evidence based medicine, using randomized controlled trials and meta-analyses as the major tools and sources of evidence about average results for heterogeneous groups of patients, developed as a reaction against poorly designed observational treatment research and physician reliance on personal experience with other patients as a guide to decision-making about a patient at hand. However, these tools do not answer the clinician's question: "Will a given therapeutic regimen help my patient at a given point in her/his clinical course?" We introduce fine-grained profiling of the patient at hand, accompanied by comparative evidence of responses from approximate matches to this patient on whom a contemplated treatment has/has not been administered. This represents medicine based evidence that is tuned to decision-making for the particular patient.