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Comment & Response
December 2018

Precision Psychiatry—Yes, But Precisely What?—Reply

Author Affiliations
  • 1Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
  • 2Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 3Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, La Jolla
  • 4Veterans Affairs San Diego Healthcare System, San Diego, California
JAMA Psychiatry. 2018;75(12):1303. doi:10.1001/jamapsychiatry.2018.2656

In Reply Gómez-Carrillo et al suggest that precision psychiatry will be impossible unless it “…integrates multilevel explanatory models with cross-level dynamics and situates individuals’ illness experience within a social context.” The authors claim that our Viewpoint relies on a “…view [that] perpetuates current reductive explanatory approaches.” We of course agree with the importance of social and environmental context and of treating individuals as whole persons. However, our Viewpoint was oriented toward providing specific examples of how genomic insights can advance precision medicine in ways that may illustrate opportunities for psychiatry. At no point did we argue that psychiatry should be reduced to genomics. Indeed, in our Viewpoint,1 we explicitly alluded to the common definition of precision medicine as “…a project to improve the diagnosis, prevention, and treatment of disease by accounting for individual differences in genes, environment, and lifestyle.” Whereas our Viewpoint provides specific examples of how genomics might inform treatment, the authors of the letter do not provide any details about how a “meaning-centered level of explanation” should be operationalized to improve diagnosis, prevention, or treatment. Such specifics will be needed “to achieve a true paradigm shift,” as they put it.

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