All for one and one for all

I wanted to bring to your attention this phrase, which was popularized as the motto of the Three Musketeers from the homonymous 1844 novel by Alexandre Dumas, but is also the unofficial motto of Switzerland since the late 19th century, as the archetype of fraternal cooperation: every one is ready to support the group and the group as a whole is ready to support every individual member. In that same spirit it was uttered by the four Catholic regents involved in the Second Defenestration of Prague in 1618 that they would stand together the judgement of the Protestant lords. In the end, only two of them (and one secretary) were thrown out of the third floor window and miraculously survived the fall, but that is a story for another day.

Photo: Chris Morgan

As is the case in any group, standing together requires giving up a certain part of our individuality: being a part of a sports team or a military unit, wearing a uniform forces us to give up the individual expression in the clothes we were, but in exchange strengthens the team spirit. However, the marketing teams know well enough that every aspect of our individuality that we give up is one opportunity less to sell us something, so for years (but most notably since the coming of the smartphones in the late 2000s) they have been gathering information about each one of us in an effort to offer exactly the products that we are most likely to buy, ideally even before we know we want it. The idea is tantamount to interpreting the motto as "to every customer, all the products that he wants, and each product to all the customers that want it".

In spite of the strong trend to ever finer customization, there is a field where brute force is still the law of the land: healthcare services. It is remarkable that, in spite of the advances in genetic analysis, big data, bioinformatics and so forth, successes as the 95% efficiency of the COVID-19 vaccines are the exception and not the norm. Indeed, many drugs have made it to the market with very low rates of success (below 50%), which means that half of the patients that get that drug for treating a condition will not see any relief or the side effects will outweigh the relief it provides.

How is it possible that drugs work so bad statistically? The answer lies precisely in the grouping: most of the drugs in use these days were developed twenty, thirty years ago or even longer, when then tools to analyze the results were still very primitive: the drug was typically tested on a Petri dish with some human cells or in lab rats, but it was never possible to study in detail the chemical mechanisms that made the drug work, let alone the peculiarities of individuals which might be under- or oversensitive to the drug. In most cases, the study went ahead with a core group of test patients that typically discarded "problematic individuals": minorities, elderly, children and women.

However, this "normalization" of the human species does not happen only in clinical trials: even in every day life human are expected, by default (at least in western societies), to be tall, young, white, lean, haired, athletic, extroverted,... and male. This is so much so that deviations from this "canon" are considered fringe cases or, even worse, pathological. For instance, there is no discussion these days that the complexion (essentially the natural mass of the body) and the character (the affinity for social interaction) show a strong range of variation among humans and is strongly conditioned by genetics and developmental factors during our childhood. And yet, heavier and introverted people are often judged as sick or even "weak of character", essentially blaming them for their condition. 

Furthermore, it is often the case that people with these disposition, rather than having low self-control frequently show remarkable strength: many people deemed "fat" or "shy" spend their lives making superhuman efforts to conform with the norm that the "naturally lean" and the extroverts never have to face. And the same kind of treatment is applied to mental health problems such as depression, which is often dismissed with a "Come on, cheer up!" as if the person in question were not trying (without success) to get out of bed.

My hope is that the technology developed for the vaccine against COVID-19 will be the beginning of a whole new family of personalized medical treatments that would recognize the diversity of the human being and ensure the effectiveness by understanding the initial biochemical situation inside each patient and the effects of the drugs on them. I hope you have a nice evening.