It has been known for decades that most human biological differences are not between groups, they are within individuals. It’s strange that scientists and doctors still resort to sifting people into huge populations when trying to understand us: ethnicity, race, sex, and gender. 2024 will mark the year they finally shed their reliance on these broad categories and begin to focus on the individual.
To give one example of how crude the population approach can be: women are less likely to be diagnosed with heart attacks even when they experience typical symptoms of a heart attack – because people tend to associate heart attacks with men. What matters for this and most other common conditions is not the patient’s gender, but their specific symptoms. Every woman (and man and non-binary person) is physiologically different from the next. Flattened categories that focus on the statistically “typical” patient in each group ignore this complexity.
Sometimes the use of categories is purely pseudoscientific with devastating consequences. In 2021 The National Football League in the United States has made the long-awaited decision to end its controversial use of “race rationing,” which assumed that black players with brain disabilities had lower levels of cognitive function to begin with. As a result, black players are less likely to receive financial compensation for injuries. NFL move ricochets in science and medicine. A compelling case has already been made against the use of race-based equations in the assessment of renal function, with many laboratories now abandoning the practice.
In 2024 scientists will finally move toward understanding each person as a multifaceted individual. Achieving this level of detail may seem unmanageable for health services and medical researchers working with millions of patients, but we have now entered an age where data collection and processing power offer the capacity to do just that. Along with advances in personal genome analysis and information about physical activity, diet, stress, and hormonal and menstrual cycles potentially available through our own devices, researchers can know more about individual patients than ever before.
For example, the family-based community group PatientsLikeMe, which launched in 2005, brought together patients with complex conditions like infertility and lupus and gave them a space to share their experiences in great detail. Not only can the patient see what treatments are working for others, but they can also let others know what treatments are working for them. This data is in turn used to inform health research. Based in Cambridge, Massachusetts, the platform now has more than 850,000 members.
When any of us take a drug for the first time, it is vital to know that it is safe and effective for most people, but it is even more important to know that it will not harm us personally. At the University of Pennsylvania, David Lydon-Staley of the Addiction, Health and Adolescence Laboratory asks if it is possible to conduct trials where n=1. For two weeks, he tested melatonin gum on himself almost like a clinical trial to see if they could help him sleep better. The goal was not to find out if the gums worked most people but to find out if they worked for himthe person who needed them. (In his case, they didn’t, by the way.)
It’s a stand-alone approach and may not fit badly with the way modern clinical trials work, but it points to a different kind of science about human differences. By moving from population-level to individual-level studies, in 2024 scientists will also begin to paint a more detailed portrait of who we are as a species. The challenge is how to do this securely without compromising privacy and how to include every single person on the planet, not just a few.
