The new holism: P4 systems medicine and the medicalization of health and life itself

TLDR

Systems medicine, or P4 medicine, is a post‑genomic, holistic approach that applies systems biology to healthcare, promising a shift from reductionist to comprehensive biomedical practice. The article examines how P4 medicine defines holism in both its methods and its understanding of health and disease. The authors explain holistic medicalization, assess its potential harms, and advocate quaternary prevention to mitigate overmedicalization. They find that P4 medicine embodies a technoscientific holism that expands medicalization into a life‑spanning, all‑encompassing regime, thereby medicalizing health and life itself.

Abstract

The emerging concept of systems medicine (or 'P4 medicine'—predictive, preventive, personalized and participatory) is at the vanguard of the post-genomic movement towards 'precision medicine'. It is the medical application of systems biology, the biological study of wholes. Of particular interest, P4 systems medicine is currently promised as a revolutionary new biomedical approach that is holistic rather than reductionist. This article analyzes its concept of holism, both with regard to methods and conceptualization of health and disease. Rather than representing a medical holism associated with basic humanistic ideas, we find a technoscientific holism resulting from altered technological and theoretical circumstances in biology. We argue that this holism, which is aimed at disease prevention and health optimization, points towards an expanded form of medicalization, which we call 'holistic medicalization': Each person's whole life process is defined in biomedical, technoscientific terms as quantifiable and controllable and underlain a regime of medical control that is holistic in that it is all-encompassing. It is directed at all levels of functioning, from the molecular to the social, continual throughout life and aimed at managing the whole continuum from cure of disease to optimization of health. We argue that this medicalization is a very concrete materialization of a broader trend in medicine and society, which we call 'the medicalization of health and life itself'. We explicate this holistic medicalization, discuss potential harms and conclude by calling for preventive measures aimed at avoiding eventual harmful effects of overmedicalization in systems medicine (quaternary prevention).