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Monday, August 3, 2026

Cult of personality

From Wikipedia, the free encyclopedia

A cult of personality, or a cult of the leader, is the result of an effort to create an idealized and heroic image of an admirable leader, often through unquestioning flattery and praise.

Historically, it has been developed through techniques such as the manipulation of the mass media, the dissemination of propaganda, the staging of spectacles, the manipulation of the arts, the instilling of patriotism, and government-organized demonstrations and rallies. A cult of personality is similar to apotheosis (deification), except that it is established through the use of modern social engineering techniques, and it is usually established by the state or the party in one-party states and dominant-party states. Cults of personality often accompany the leaders of totalitarian or authoritarian governments. They can also be found in some monarchies, theocracies, failed democracies, and liberal democracies.

Background

Augustus of Prima Porta, 1st century CE

Throughout human history, monarchs and other heads of state were frequently treated with enormous reverence, and they were also thought to be endowed with superhuman qualities. Through the principle of the divine right of kings, notably in medieval Europe, rulers were said to hold office by the will of God or the will of the gods. Ancient Egypt, Imperial Japan, the Inca, the Aztecs, Tibet, Siam (now Thailand), and the Roman Empire are especially noted for their redefinition of monarchs as "god-kings." The Emperor of China also used the title Son of Heaven. Furthermore, the Imperial cult of ancient Rome identified emperors and some members of their families with the divinely sanctioned authority (auctoritas) of the Roman State.

The spread of democratic and secular ideas in Europe and North America in the 18th and 19th centuries made it increasingly difficult for monarchs to preserve this aura, though Napoleon III and Queen Victoria appreciated its perpetuation in their carte-de-visite portraits which proliferated, circulated and were collected in the 19th century.

The subsequent development of mass media, such as radio, enabled political leaders to project a positive image of themselves onto the masses as never before. It was under these circumstances in the 20th century that the most notorious personality cults arose. Frequently, these cults are a form of political religion.

The advent of the Internet and the World Wide Web in the 21st century has renewed the personality cult phenomenon. Disinformation via social media platforms and the twenty-four hour news cycle has enabled the widespread dissemination and acceptance of deceptive information and propaganda. As a result, personality cults have grown and remained popular in many places, corresponding with a marked rise in authoritarian government across the world.

The term "cult of personality" likely appeared in English around 1800–1850, along with the French and German versions of the term. It initially had no political connotations but was instead closely related to the Romanticist "cult of genius." The first known political use of the phrase appeared in a letter from Karl Marx to German political worker Wilhelm Blos dated to November 10, 1877:

Neither of us cares a straw of popularity. Let me cite one proof of this: such was my aversion to the personality cult [orig. Personenkultus] that at the time of the International, when plagued by numerous moves ... to accord me public honor, I never allowed one of these to enter the domain of publicity ...

Characteristics

1859 carte de visite of Napoleon III by Disdéri, which popularized the carte-de-visite format

There are various views about what constitutes a cult of personality in a leader. Historian Jan Plamper wrote that modern-day personality cults display five characteristics that set them apart from "their predecessors": The cults are secular and "anchored in popular sovereignty"; their objects are all males; they target the entire population, not only the well-to-do or just the ruling class; they use mass media; they exist where the mass media can be controlled enough to inhibit the introduction of "rival cults."

In his 2013 paper, "What is character and why it really does matter," Thomas A. Wright stated, "The cult of personality phenomenon refers to the idealized, even god-like, public image of an individual consciously shaped and molded through constant propaganda and media exposure. As a result, one is able to manipulate others based entirely on the influence of public personality ... the cult of personality perspective focuses on the often shallow, external images that many public figures cultivate to create an idealized and heroic image."

Adrian Teodor Popan defined a cult of personality as a "quantitatively exaggerated and qualitatively extravagant public demonstration of praise of the leader." He also identified three causal "necessary, but not sufficient, structural conditions and a path-dependent chain of events which, together, lead to the cult formation: a particular combination of patrimonialism and clientelism, lack of dissidence, and systematic falsification pervading the society's culture."

One underlying characteristic, as explained by John Pittman, is that the cult of personalities is patriarchal in nature. The idea of a cult of personality associated with the Marxist movements gains popular footing among the men in power, with the idea that they would be the "fathers of the people." By the end of the 1920s, the male features of the cults became more extreme. Pittman identifies that these features became roles, including the "formal role for a [male] 'great leader' as a cultural focus of the apparatus of the regime: reliance on top-down 'administrative measures' and a pyramidal structure of authority," which was created by a single ideal.

Role of mass media

Writing in 2013, Thomas A. Wright observed that "[i]t is becoming evident that the charismatic leader, especially in politics, has increasingly become the product of media and self-exposure." Focusing on the media in the United States, Robert N. Bellah added, "It is hard to determine the extent to which the media reflect the cult of personality in American politics and to what extent they have created it. Surely they did not create it all alone, but just as surely they have contributed to it. In any case, American politics is dominated by the personalities of political leaders to an extent rare in the modern world ... in the personalized politics of recent years, the 'charisma' of the leader may be almost entirely a product of media exposure."

Purpose

Napoleon Crossing the Alps, romantic version by Jacques-Louis David in 1805

Jan Plamper argues while Napoleon III made some innovations in France, it was Benito Mussolini in Italy in the 1920s who originated the model of dictator-as-cult-figure that was emulated by Hitler, Stalin and the others, using the propaganda powers of a totalitarian state.

Pierre du Bois de Dunilac argues that the Stalin cult was elaborately constructed to legitimize his rule. Many deliberate distortions and falsehoods were used. The Kremlin refused access to archival records that might reveal the truth, and key documents were destroyed. Photographs were altered, and documents were invented. People who knew Stalin were forced to provide "official" accounts to meet the ideological demands of the cult, especially as Stalin himself presented it in 1938 in Short Course on the History of the All-Union Communist Party (Bolsheviks), which became the official history.

Historian David L. Hoffmann states, "The Stalin cult was a central element of Stalinism, and as such it was one of the most salient features of Soviet rule ... Many scholars of Stalinism cite the cult as integral to Stalin's power or as evidence of Stalin's megalomania."

In Latin America, Cas Mudde and Cristóbal Rovira Kaltwasser link the "cult of the leader" to the concept of the caudillo, a strong leader "who exercises a power that is independent of any office and free of any constraint." These populist strongmen are portrayed as "masculine and potentially violent" and enhance their authority through the use of the cult of personality. Mudde and Kaltwasser trace the linkage back to Juan Perón of Argentina.

States and systems with personality cults

Argentina

"Smith of the New Great Argentina" (poster 1947)

Juan Perón, who was elected three times as President of Argentina, and his second wife, Eva "Evita" Perón, were immensely popular among many of the Argentine people, and to this day they are still considered icons by the leading Justicialist Party. In contrast, both academics and detractors often considered him a demagogue and a dictator. Perón sympathized with the Axis powers when he was a colonel and Minister of War and even served as a diplomatic envoy to Fascist Italy. During his regime, he kept close ties with Francoist Spain.

He ferociously persecuted dissenters and potential political rivals, as political arrests were common during his first two terms. He eroded the republican principles of the country as a way to stay in power and forced statewide censorship on most media. Following his election, he built a personality cult around both himself and his wife so pervasive it is still a part of Argentina's current political life.

During Perón's regime, schools were forced to read Evita's biography, La Razón de mi Vida, union and government jobs were only given to those who could prove themselves to be fervent Peronists; newspapers were censored, and television and radio networks were nationalized, with only state media being allowed. He often showed contempt for any opponents, regularly characterizing them as traitors and agents of foreign powers. Those who did not fall in line or were perceived as a threat to Perón's political power were subject to losing their jobs, threats, violence, and harassment.

Perón dismissed over 20,000 university professors and faculty members from all major public education institutions. Universities were then intervened in, the faculty was pressured to get in line, and those who resisted were blacklisted, dismissed or exiled. Numerous prominent cultural and intellectual figures were imprisoned. Thousands of artists, scientists, writers and academics left the country and migrated to North America or Europe. Union leaders and political rivals were arrested and tortured for years and were only released after Perón was deposed.

Azerbaijan

Bangladesh

Mritunjoyi Mujib at Islamic University in Kushtia. It was demolished after the Student–People's uprising in August 2024.

Mujibism initially began as the political ideology of Sheikh Mujibur Rahman ("Mujib," 1920-1975), who led Bangladesh's secession from Pakistan in 1971. From 2008 onwards, Mujib's daughter, Sheikh Hasina, gradually converted Mujibism into a cult of personality around her father. After being pushed to the sidelines by two successive military dictators Ziaur Rehman (who founded the Bangladesh Nationalist Party) and Hussain Muhammad Ershad (who founded the National Party)—the figure of the late Mujib returned to dominate public consciousness from 2008 under the Awami League government led by Hasina.

Hasina has been criticized for overemphasizing the role of her father and of the Awami League in securing Bangladeshi independence at the cost of sidelining other prominent figures and political parties of the time. Hasina had amended the constitution to make the presence of Mujib's portrait mandatory in every school, government office and diplomatic mission in the country and made it illegal to criticize Mujib, his ideals or his deeds, especially the one-party BAKSAL regime (1972–75) headed by him, through writing, speech or electronic media. Many events commemorating the birth centenary of Bangabandhu ('Friend of Bengal' in Bengali, the honorific unofficial title given to Mujib in his lifetime) were launched by the Hasina administration, including an official biopic in collaboration with the Indian government.

The Hasina government converted Mujib's residence in the capital city of Dhaka, where he and his family were assassinated by mutinous military personnel in 1975, into a memorial museum. Hasina designated the day of Mujib's assassination as the National Day of Mourning. The Hasina government also made the birthdays of Mujib, his wife Sheikh Fazilatunessa, eldest son Sheikh Kamal, and youngest son Sheikh Russel official government holidays, alongside March 7 (on that day in 1971, Mujib declared Bangladesh's secession at a speech in Dhaka).

Under Hasina's rule, the country was dotted with numerous statues of Mujib alongside several roads and prominent institutions named after him. Critics state that Hasina utilized the personality cult around her father to justify her own authoritarianism, crackdown on political dissent, and democratic backsliding of the country. Following the violent overthrow of Sheikh Hasina in 2024, the cult of personality around Mujib is being systematically dismantled.

Brazil

Bulgaria

Cambodia

The Cambodian leader Pol Pot ("Saloth Sar") became "Brother Number One" as the secretive public figure, and the regime did not cultivate a cult of personality around him. Instead, he and the Khmer Rouge used the faceless, abstract concept of Angkar (អង្គការ angkaa), a Khmer word for "Organization" to represent the revolutionary party in Cambodia. Following the Fall of Phnom Penh and the end of the Cambodian Civil War on 17 April 1975, Angkar was presented as the supreme, all-knowing authority to whom all loyalty was owed, as it sees everything, and was used to assert the organization's total control over Democratic Kampuchea as its constitution on 5 January 1976. As the highest authority, Angkar was part of the regime's clandestine Maoist ideology.

The Cambodian People's Party (CPP) won all 125 seats in the 2018 general election, effectively turning the country into a single-party state as part of the political landscape has undergone a dynastic transition of Hun Sen (who has been in power as Prime Minister from 1985 until 2023) and his son Hun Manet. Sen remained president of the ruling CPP, which political analysts say gives him ultimate control over the country, while his son Hun Manet became the next Prime Minister since August 2023, but the CPP itself was an entity, not a personality cult.

Chile

China

ROC-China propaganda poster proclaiming "Long Live the President", glorifying Chiang Kai Shek
Statue of Mao Zedong in China

Mao Zedong's cult of personality was a prominent part of Chairman Mao Zedong's rule over the People's Republic of China from his rise in 1949 until his death in 1976. Mass media, propaganda and a series of other techniques were used by the state to elevate Mao Zedong's status to that of an infallible heroic leader, who could stand up against The West, and guide China to become a beacon of Communism. Mao himself, however, publicly criticized the personality cult that was formed around him.

During the period of the Cultural Revolution, Mao's personality cult soared to an unprecedented height. Mao's face was firmly established on the front page of People's Daily, where a column of his quotes was also printed every day. Mao's Selected Works were later printed in even greater circulation; the number of his portraits (1.2 billion) was more than the inhabitants in China. And soon Chairman Mao badges began to appear; in total, about 4.8 billion were manufactured.

Every Chinese citizen was presented with the Little Red Book – a selection of quotes from Mao. It was prescribed to be carried everywhere and displayed at all public events, and citizens were expected to quote the contents of the book daily. Mao himself believed that the situation had gone out of hand, and in a conversation with Edgar Snow in 1970, he denounced the titles of "Great Leader, Great Supreme Commander, Great Helmsman" and insisted on only being called "teacher." Admiration for Mao Zedong has remained widespread in China in spite of somewhat general knowledge of his actions. In December 2013, a Global Times poll revealed that over 85% of Chinese viewed Mao's achievements as outweighing his mistakes.

Chiang Kai-shek had a cult of personality. His portraits were commonly displayed in private homes, and they were also commonly displayed in public on the streets. When the Muslim general and warlord Ma Lin was interviewed, he was described as having "high admiration for and unwavering loyalty to Chiang Kai-shek."

After the Cultural Revolution, Deng Xiaoping and others launched the "Boluan Fanzheng" program, which invalidated the Cultural Revolution and abandoned (and forbade) the use of a personality cult.

A cult of personality has been developing around Xi Jinping since he became General Secretary of the ruling Chinese Communist Party and the regime's paramount leader in 2012.

Dominican Republic

Longtime dictator of the Dominican Republic Rafael Trujillo (ruled 1930–1961) was the center of a large personality cult. The nation's capital city, its highest peak, and a province were renamed for him. Statues of "El Jefe" were mass-produced and erected across the country, and bridges and public buildings were named in his honor.

Automobile license plates included slogans such as "¡Viva Trujillo!" and "Año Del Benefactor De La Patria" (Year of the Benefactor of the Nation). An electric sign was erected in Ciudad Trujillo so that "Dios y Trujillo" could be seen at night as well as in the day. Eventually, even churches were required to post the slogan "Dios en el cielo, Trujillo en la tierra" (God in Heaven, Trujillo on Earth). As time went on, the order of the phrases was reversed (Trujillo on Earth, God in Heaven).

Haiti

François Duvalier, also known as Papa Doc, was a Haitian politician who served as the president of Haiti from 1957 until his death in 1971. He was elected president in the 1957 general election on a populist and black nationalist platform. After thwarting a military coup d'état in 1958, his regime rapidly became more autocratic and despotic.

An undercover government death squad, the Tonton Macoute (Haitian Creole: Tonton Makout), indiscriminately tortured or killed Duvalier's opponents; the Tonton Macoute was thought to be so pervasive that Haitians became highly fearful of expressing any form of dissent, even in private. Duvalier further sought to solidify his rule by incorporating elements of Haitian mythology into a personality cult.

Hungary

Nazi official with a portrait of Miklós Horthy, 1940

The cult of Miklós Horthy, who became the head of state of the Kingdom of Hungary after the dissolution of Austria-Hungary and the counter-revolutionary terror after World War I, was one of the first personality cults to be established in interwar Europe. Horthy was presented as the only person capable of achieving the national goals and restoring the lost national glory. Horthy built the Hungarian national identity around Christianity, and in order to maintain his own cult, Horthy actively manipulated Christian symbols and concepts, namely resurrection, rebirth, salvation, the Passion of the Christ, selectness, the promised land, and references to the will of divine providence for justifying Horthy's rule.

India

Lithograph printed in 1910 from Bombay's Ravi Varma Press, depicting the Hindu God Shiva's Kalantaka form, protecting Markandeya (who is hugging a Shivalinga) from the snares of Yama
 
Lithograph printed in 1930s, heavily plagiarizing from the original one, with Gandhi posing as Shiva, protecting Bharat Mata (who replaces Markandeya in this version) from the snares of a British colonial officer, who is labelled as Yama

During the days of the freedom struggle, Mahatma Gandhi had a cult-like following amongst the people of India. Congress leaders like Chittaranjan Das and Subhash Chandra Bose, who opposed Gandhi's methods, found themselves sidelined within the party. The assassination of Gandhi in 1948 led to widespread violence against Marathi Brahmins by his followers.

After Gandhi's death, his cult was eclipsed by another personality cult that had developed around India's first prime minister, Jawaharlal NehruC Rajagopalachari criticized the personality cult surrounding Nehru, saying that there should be an opposition group within the Congress. Rajagopalachari later formed the economically right-wing Swatantra Party in opposition to Nehru's socialist economic view. The expression 'Nehruvian consensus' reflects the dominance of Nehruvian ideals, a product of Nehru's personality cult and the associated statism, i.e., the overarching faith in the state and the leadership. However, Nehru himself actively discouraged the creation of a cult of personality around him. He wrote an essay titled 'Rashtrapati' in 1937 published in the Modern Review warning people about dictatorship and emphasizing the value of questioning leaders.

The Congress party has been accused of promoting a personality cult centered around Nehru, his daughter Indira Gandhi, and the Nehru-Gandhi family. Indira Gandhi has also been described as having a cult of personality during her administration. Following India's victory in the 1971 Indo-Pak war, Gandhi was hailed by many as a manifestation of the Hindu goddess Durga. In that year, Gandhi nominated herself for the Bharat Ratna, the highest civilian award in the country. During the Emergency period, the then Congress party president, Devakanta Barooah, had remarked, 'India is Indira, Indira is India.'

Her assassination in 1984 by her Sikh bodyguards sparked a massive wave of public grief and anti-Sikh violence. The Congress party, led by her son Rajiv Gandhi, utilized her death to win the general elections held shortly after. His assassination while campaigning in the 1991 general elections also led to widespread public grief, which was utilized by the Congress to win the elections despite unfavorable circumstances.

Current Indian Prime Minister Narendra Modi is often criticized for creating a personality cult around himself. Despite some setbacks and criticism, Modi's charisma and popularity were key factors that helped the Bharatiya Janata Party (BJP) return to power in the 2019 general electionsShivraj Singh Chouhan, the chief minister of the country's second largest state, said in 2022, "He is superhuman and has traces of God in him." The opposition often accused Modi of spreading propaganda using popular media such as movies, television and web series. Modi is often accused of having narcissistic traits.

In 2015, Modi wore a suit that has his name embroidered all over it in fine letters like a Hindu namavali (A sheet of cloth printed all over with the names of Hindu gods and goddesses usually worn by Hindu priests during puja) while greeting US president Barack Obama during his bilateral visit to India. This suit was auctioned that year, selling at a record amount of 43.1 million Indian rupees, thereby earning the Guinness World Record for the most expensive suit.

In 2019, a biographical film of Modi was released, which was heavily criticized for its hagiographical nature. In 2021, Modi named the world's largest cricket stadium after himself. During the 2024 general elections, Modi tried to divinize himself in an interview in which he stated that he viewed himself to be sent directly by God to serve a special purpose on Earth. BJP spokesperson Sambit Patra while campaigning in the Hindu holy city of Puri stated that even Jagannath (the form of the Hindu god Vishnu that is venerated there) worships Modi.

The BJP is also stated to have created a cult of personality around Hindu Mahasabha leader V. D. Savarkar and Gandhi's assassin Nathuram Godse to oppose the dominance of Gandhian philosophy in Indian society. In addition to Modi, Yogi Adityanath is also described as having built a cult-like following among Hindutva fundamentalists. An attempt has been made in the internet to link Modi & Yogi with a series of 16th century apocalyptic prophecies by the Achyutananda Dasa, which supposedly herald the arrival of Kalki in a manner similar to how Donald Trump has been linked with the Rapture in certain circles of American evangelicalism.

Citizens of India bow to the statues of B. R. Ambedkar in 2014.

One study claims that India's political culture since the decline of the Congress' single-handed dominance over national politics from the 1990s onwards as a fallout of the Ram Janmabhoomi movement and Mandal Commission protests has paved the way for personality cults centered around leaders of the small regional parties, derived from hero-worship of sportspersons and film industry celebrities and the concept of bhakti, which in turn has fostered nepotism, cronyism and sycophancy. Among these leaders, Tamil Nadu Chief Minister J. Jayalalitha had one of the most extensive ones.

She was widely referred to by leaders and members of her party as Amma ('mother' in Tamil, also used to refer to Hindu goddesses), and they would prostrate themselves before her. She would be regularly publicly applauded with Tamil titles like Makkalin Mudhalvar (people's chief minister), Puratchi Thalaivi (revolutionary female leader), Thanga Thalaivi (golden female leader), etc. by her cadres. Her government provided various kinds of subsidized goods under the brand name of Amma. Widespread violence broke out throughout the state when she was arrested on charges of corruption.

A huge wave of public grief swept all over the state, with some even committing suicide, following her death in 2016. Another leader, Mayawati, was also known for attempting to foster a cult of personality during her tenure as the Chief Minister of India's most populous state by getting constructed large statues of herself and the elephant (which was the electoral symbol of her party) that were installed in public parks at the cost of the government exchequer.

Historical personalities are also deified to the level of cult worship long after their lifetimes, which is utilized by politicians to woo their followers for electoral purposes. Prominent examples are the cult of Shivaji in Maharashtra and the cult of Dr. B. R. Ambedkar among Dalits.

Iraq

As a sign of his consolidation of power as Iraq's dictator, Saddam Hussein's personality cult pervaded Iraqi society. He had thousands of portraits, posters, statues and murals erected in his honor all over Iraq. His face could be seen on the sides of office buildings, schools and classrooms, airports, and shops, as well as on all denominations of Iraqi currency (the dinar).

Saddam's personality cult reflected his efforts to appeal to the various elements in Iraqi society. This was seen in his variety of apparel: he appeared in the costumes of the Bedouin, the traditional clothes of the Iraqi peasant (which he essentially wore during his childhood), and even appeared in Kurdish clothing, but he also appeared in Western suits fitted by his favorite tailor, projecting the image of an urbane and modern leader. Sometimes he would also be portrayed as a devout Muslim, wearing a full headdress and robe, praying towards Mecca, but most often he was depicted wearing a military uniform.

Israel

Critics of Benjamin Netanyahu, the current and longest-serving prime minister of Israel and leader of the opposition when not in power, and some observers have described him as enjoying a personality cult. A study claims that Netanyahu has created popularity and maintained power by setting a narrative in which Iran was acquiring the capacity to annihilate Israel and "wreak havoc upon the Western world" and in which the Jews are again threatened by an antisemitic regime unless Israel leads a preventative response, while constructing a cult of personality and promising security to all Israelis, and thus, solidifying his support through an "orchestrated unity," which includes the ritual of the leader offering security in return for the people's exchange of gratitude.

Isabel Kershner writes that Netanyahu's "most loyal base" "had built something of a personality cult around him," while the two main political blocks of Israel center on his personality and can be described as "Only Bibi" and "Anyone but Bibi." Critics who accused Netanyahu of a personality cult include the opinion journalists Gershon Baskin and Pamela Peled of The Jerusalem Post.

Italy

"Kids, you have to love Benito Mussolini. He always works for the good of the Fatherland and the Italian people. You have heard this many times, from your dad, mom, or teacher: If Italy is now far more powerful than before, we owe it to Him." (1936 first-grade textbook)

Benito Mussolini was portrayed as the embodiment of Italian Fascism, and as a result, he was keen to be seen as such. Mussolini was styled by other Italian fascists as Il Duce ("The Leader"). Since Mussolini was represented as an almost omniscient leader, a common saying in Italy during Mussolini's rule was "The Duce is always right" (Italian: Il Duce ha sempre ragione). Mussolini became a unifying force in Italy in order for ordinary Italians to put their differences to one side with local officials. The personality cult surrounding Mussolini became a way for him to justify his personal rule, and it acted as a way to enable social and political integration.

Mussolini's military service in World War I and survival of failed assassination attempts were used to convey a mysterious aura around him. Fascist propaganda stated that Mussolini's body had been pierced by shrapnel just like St. Sebastian had been pierced by arrows, the difference being that Mussolini had survived this ordeal. Mussolini was also compared to St. Francis of Assisi, who, like Mussolini, "suffered and sacrificed himself for others."

The press was given instructions on what to write and what not to write about Mussolini. Mussolini himself authorized which photographs of him were allowed to be published and rejected any photographs that made him appear weak or less prominent than he wanted to be portrayed as in a particular group.

Italy's war against Ethiopia (1935–37) was portrayed in propaganda as a revival of the Roman Empire, with Mussolini as the first Roman emperor Augustus. To improve his own image, as well as the image of Fascism in the Arab world, Mussolini declared himself to be the "Protector of Islam" during an official visit to Libya in 1937.

Germany

A portrait of Hitler by Albert Reich (1881–1942)

Starting in the 1920s, during the early years of the Nazi Party, Nazi propaganda began to depict the Nazi leader Adolf Hitler as a demagogue figure who was the almighty defender and savior of Germany. After the end of World War I (1918) and the Treaty of Versailles (1919), the German people experienced turmoil under the Weimar Republic, and, according to Nazi propaganda, only Hitler could save them and restore Germany's greatness, which in turn gave rise to the "Führer-cult."

During the five election campaigns in 1932, the Nazi newspaper Völkischer Beobachter portrayed Hitler as a man who had a mass movement united behind him, a man with one mission to solely save Germany as the 'Leader of the coming Germany'. The Night of the Long Knives in 1934—after which Hitler referred to himself as being single-handedly "responsible for the fate of the German people"—also helped to reinforce the myth that Hitler was the sole protector of the Volksgemeinschaft, the ethnic community of the German people.

Nazi Propaganda Minister Joseph Goebbels cultivated an image of Hitler as a "heroic genius". The myth also gave rise to the saying and concept, "If only the Führer knew." Germans thought that problems that they ascribed to the Nazi hierarchy would not have occurred if Hitler had been aware of the situation; thus, Nazi bigwigs were blamed, and Hitler escaped criticism. British historian Ian Kershaw published his book The "Hitler Myth": Image and Reality in the Third Reich in 1987 and wrote:

Hitler stood for at least some things they [German people] admired, and for many had become the symbol and embodiment of the national revival which the Third Reich had in many respects been perceived to accomplish.

Adolf Hitler in Bad Godesberg, Germany, 1938

During the early 1930s, the myth was given credence due to Hitler's perceived ability to revive the German economy during the Great Depression. However, Albert Speer wrote that by 1939, the myth was under threat, and the Nazis had to organize cheering crowds to turn up to events. Speer wrote:

The shift in the mood of the population, the drooping morale which began to be felt throughout Germany in 1939, was evident in the necessity to organize cheering crowds where two years earlier Hitler had been able to count on spontaneity. What is more, he himself had meanwhile moved away from the admiring masses. He tended to be angry and impatient more often than in the past when, as still occasionally happened, a crowd on Wilhelmsplatz began clamoring for him to appear. Two years before he had often stepped out on the "historic balcony." Now he sometimes snapped at his adjutants when they came to him with the request that he show himself: "Stop bothering me with that!"

The myth helped to unite the German people during World War II, especially against the Soviet Union and the Western Allies. During Hitler's early victories against Poland and Western Europe, the myth was at its peak, but when it became obvious to most Germans that the war was lost, then the myth was exposed and Hitler's popularity declined. A report is given in the little Bavarian town of Markt Schellenberg on March 11, 1945:

When the leader of the Wehrmacht unit at the end of his speech called for a Sieg Heil for the Führer, it was returned neither by the Wehrmacht present, nor by the Volkssturm, nor by the spectators of the civilian population who had turned up. This silence of the masses ... probably reflects better than anything else, the attitudes of the population.

Mexico

North Korea

Citizens of North Korea bow to statues of Kim Il Sung and Kim Jong Il in 2014

The cult of personality which surrounds North Korea's ruling family, the Kim family, has existed for decades and it can be found in many aspects of North Korean culture. Although not acknowledged by the North Korean government, many defectors and Western visitors state there are often stiff penalties for those who criticize or do not show "proper" respect for the regime. The personality cult began soon after Kim Il Sung took power in 1948, and was greatly expanded after his death in 1994.

The pervasiveness and the extreme nature of North Korea's personality cult surpasses those of Joseph Stalin and Mao Zedong. The cult is also marked by the intensity of the people's feelings for and devotion to their leaders, and the key role played by a Confucianized ideology of familism both in maintaining the cult and thereby in sustaining the regime itself. The North Korean cult of personality is a large part of Juche and totalitarianism.

Yakov Novichenko, a Soviet military officer who saved Kim Il Sung's life on 1 May 1946, is reported to also have developed a cult of personality around 1984. He is considered the only non-Korean to have developed a cult of personality there.

Peru

Philippines

Ferdinand Marcos (pictured with his daughter Imee) was a Philippine dictator and kleptocrat. His regime was infamous for its corruption.

Ferdinand Marcos developed a cult of personality in order to stay in power for 20 years as president of the Philippines, a dictatorship marked by political corruption and human rights violations. His administration’s personalist ideology and policies, combining veneration and idolization of Marcos himself with extreme populism and ultranationalism, have been compared to those of other totalitarian and authoritarian leaders such as Joseph Stalin and Adolf Hitler, as well as to those of more recent dictators and autocrats such as Suharto in Indonesia, Saddam Hussein in Iraq, and North Korea’s Kim dynasty.

The propaganda techniques used, either by himself or by others, to mythologize Ferdinand Marcos began with local political machinations in Ilocos Norte while Ferdinand was still the young son of politician and Japanese collaborator Mariano Marcos and persist today in the efforts to revise the way Marcos is portrayed in Philippine history. According to members of his administration, such as Adrian Cristobal, Marcos's intent was to project an image of himself as "the only patron, the king" of Philippine society, which he still saw as a society of tribes." Cristobal furthers that "Marcos and the First Lady wanted more than anything else [...] to be king and queen. They wished to shape the kingdom in their own image; [...] Marcos wanted to be able to say, 'L'État, c'est moi.'" In some extreme cases where Marcos encouraged the formation of cults so that they could serve as a political weapon, Marcos came to be thought of as a God.

These propaganda narratives and techniques include: using red scare tactics such as red-tagging to portray activists as communists and to exaggerate the threat represented by the Communist Party of the Philippines; using martial law to take control of mass media and silence criticism; the use of foreign-funded government development projects and construction projects as propaganda tools; creating an entire propaganda framework around a "new society" in which he would rule under a system of "constitutional authoritarianism"; the perpetuation of hagiographical books and films; the perpetuation of propaganda narratives about Marcos's activities during World War II, which have since been proven false by historical documents; the creation of myths and stories around himself and his family; and portrayals of himself in coinage and even a Mount Rushmore-type monument; among others."

Since Ferdinand Marcos's death, propaganda efforts have been made to whitewash his place in Philippine history, an act of historical negationism commonly referred to using the more popular term "historical revisionism."

Poland

Romania

Russia

Vladimir Putin on a Harley-Davidson tricycle with a Russian biker gang on a visit to Ukraine in 2010

Russian president Vladimir Putin has created a cult of personality for himself as an outdoorsy, sporty, tough guy public image, demonstrating his physical capabilities and taking part in unusual or dangerous acts, such as extreme sports and interaction with wild animals.

Soviet Union

The first cult of personality to take shape in the USSR was that of Vladimir Lenin. Up until the dissolution of the USSR in 1991, Lenin's portrait and quotes were a ubiquitous part of the culture. However, during his lifetime, Lenin vehemently denounced any effort to build a cult of personality, as (in his eyes) the cult of personality was antithetical to Marxism. Despite this, members of the Communist Party used Lenin's image as the all-knowing revolutionary who would liberate the proletariat. Lenin attempted to take action against this; however, it was halted after Lenin was nearly assassinated in August 1918.

His health would only further decline as he suffered numerous severe strokes, with the worst in May 1922 and March 1923. In this state Lenin would lose the ability to walk and speak. During this time the Bolshevik Party began to promote the accomplishments of Lenin as the basis for a cult of personality, using him as an image of morality and of revolutionary ideas.

Propaganda poster of Lenin and Stalin

After Vladimir Lenin's death in 1924 and the exile of Leon Trotsky in 1928, Joseph Stalin came to embody the Soviet Union. Once Lenin's cult of personality had grown, creating enough influence, Stalin integrated Lenin's ideals into his own cult. Unlike other cults of personalities, the Lenin and Stalin cults were not created to give the leaders power; they were created to give power and validation to the Communist Party. Stalin initially spoke out against the cult and other outrageous and false claims centered around him. However, Stalin's attitude began to shift in favor of the cult in the 1930s, and he began to encourage it following the Great Purge of 1936 to 1938.

Seldom did Stalin object to state actions that furthered his cult of personality; however, he did oppose some initiatives from Soviet propagandists. When Nikolai Yezhov proposed to rename Moscow to Stalinodar, which translates as "gift of Stalin," Stalin objected. To merge the Lenin and Stalin cults together, Stalin changed aspects of Lenin's life in the public's eye in order to place himself in power. This kept the two cults in a line that showed that both Lenin and Stalin had the same ideas and that Stalin was the rightful successor of Lenin, leading the USSR in the fashion Lenin would have done.

Soviet poster in the Azerbaijani language featuring Stalin, 1938

In December 1929, Stalin celebrated his 50th birthday, which featured prominently in the Soviet press. The media used positive adjectives like "great," "beloved," "bold," "wise," "inspirer," and "genius" to describe him. Similarly, speeches that were given by people to the peasants described Stalin as "Our Best Collective Farm Worker," "Our Shockworker, Our Best of Best," and "Our Darling, Our Guiding Star."  By 1934, under Stalin's full control of the country, socialist realism became the endorsed method of art and literature. Even under the communist regime, the Stalin cult of personality portrayed Stalin's leadership as patriarchy under the features laid out during Khrushchev's 1956 speech. After 1936, the Soviet press described Stalin as the "Father of Nations."

Historian Kevin Morgan identifies a third period of cult-building during the time of Stalin's reign, following construction of the Lenin cult and the Stalin cult of the 1930s. Following a "relative hiatus of activity during the war years," Morgan observes, a third phase erupted coinciding with the Cold War, "attaining its climax with the commemoration of Stalin's seventieth birthday in December 1949." This post-war personality cult was paralleled by similar leader cults in the newly communist nations of central and eastern Europe, Morgan notes, including cults dedicated to Georgy Dimitrov in Bulgaria and Ernst Thälmann in East Germany.

One key element of Soviet propaganda was interaction between Stalin and the children of the Soviet Union. He was often photographed with children of different ethnic backgrounds of the Soviet Union and was often photographed giving gifts to children. In 1935 the phrase, "Thank You, Dear Comrade Stalin, for a Happy Childhood!" started to appear above doorways at nurseries, orphanages, and schools; children also chanted this slogan at festivals.

Another key element of Soviet propaganda was imagery of Stalin and Lenin. In many posters, Stalin and Lenin were placed together to show their camaraderie and that their ideals were one. Throughout the 1930s, posters with both images were used as a way to bring the nation and the military together under the policies of the Communist Party during World War II, with the idea of Lenin as the father of the revolutionary ideas and Stalin as the disciple who would fulfill the communist ideals. Stalin was also portrayed in numerous films produced by Mosfilm, which remained a Soviet-led company until the fall of the Soviet Union.

Spain

Following the outbreak of the Spanish Civil War in 1936, Francisco Franco's image was deliberately crafted through extensive nationalist propaganda that portrayed him as a messianic figure and savior of traditional Spanish values against republican and communist forces preventing Spain from becoming a Soviet puppet. The carefully constructed narrative emphasized his military prowess and Catholic piety, with state-controlled media consistently depicting him as "El Caudillo" (The Leader), a divinely appointed guardian of Spain's cultural and religious heritage.

Syria

Statue of Syrian dictator Hafez al-Assad, who is revered as their Al-Abad (Immortal Leader) by followers of Syrian Ba'athism

Syria's Hafez al-Assad, a Ba'athist officer who seized power through a coup d'état in 1970, established a pervasive cult of personality to maintain his dictatorship. As soon as he took over power, Ba'ath party loyalists designated him as "Al-Abad"; an Arabic terminology with deep religious dimensions. Linguistically, ''Al-Abad'' means "forever, infinite and immortality," and religious clerics use this term in relation to Divine Attributes. By designating Assad as "Al-Abad," the Syrian Ba'ath Movement ideologically elevated Hafez al-Assad as its "Immortal", "god-like figure" who is supposed to represent the state as well as the Syrian nation itself.

Another meaning of Al-Abad is "permanent," which is used in state propaganda to denote the perpetual status quo of an "eternal political order" created by Hafez al-Assad, who continues to embody Assadist ideology. The term's verbal form "Abada" means "to commit genocide", including the "symbolical, performative side of violence." This dimension was weaponized by the Assad regime to monopolize violence against alleged dissidents and justify state terrorism, including genocidal acts of mass murder like the Hama Massacre, Qamishli Massacre and other massacres of the Syrian civil war.

Arab Socialist Ba'ath party initially manufactured Hafez al-Assad's cult of Arab socialist heroism in consultancy with Soviet state propagandists, mimicking the pervasive personality cults prevalent across Soviet Bloc dictatorships like Romania and North Korea. Beginning as a tool to bind every Syrian citizen with the obligation of undying loyalty (bay'ah) to Assad in the 1970s, the propaganda was further intensified, and personalist depictions reached new heights during the 1980s. The state began rewriting Syrian history itself, with the Ba'ath party deifying Hafez al-Assad as their "leader for eternity" ["qa'iduna ila l-abad"] and portraying him as "the second Saladin" who guarantees Arab peoples victory over Zionist Crusaders.

Through kindergarten, school books, educational institutions and Baathist media; Assadist propaganda constructed the image of a homogenous Arab nation protected by a fatherly leader revelling under the "cult of Saladin." The Assad regime venerated Hafez al-Assad's personalist iconography perpetually in the public and private spheres of everyday Syrian life through monuments, images, murals, posters, statues, stamps, Ba'athist symbolism, currency notes, photos, banners, state TV, etc. More than a leader of the masses, Ba'athist propaganda equated Hafez al-Assad himself with "the people," apart from declaring him as the "father of the nation" and as an exceptional human being, assigning him multiple roles as a doctor, soldier, lawyer, educator, statesman, general, etc. Every civil society organization, trade union and any form of cultural or religious association in

Syria is obliged to declare their "binding covenant" to Hafez al-Assad and display his iconography in order to be legalized. The far-reaching personality cult of his father has been weaponized by Bashar al-Assad as a pillar of his regime's legitimacy and also as a supplement to enhance his own personality cult. Bashar's cult downplayed religious elements for technocratic Arab socialist themes, with a constant militaristic emphasis on conspiratorial threats from forces of Zionism due to an allegedly ongoing "dormant war with Israel".

One utilization of the personality cult had been to enable the Assad dynasty to downplay the rural Alawite origins of their family from public eyes. Images of Assad family members were installed across Syria's numerous heritage sites and monuments to wed the dynasty with Ba'athist Syrian history. Murals and statues of Hafez al-Assad and Bashar al-Assad were constructed across Syrian cities, towns, villages, etc., depicting them in the costumes of medieval Bedouins or as sultans like Harun al-Rashid. Assadist cult of personality functioned as a psychological tool for the totalitarian regime, which attempted to claim to the Syrian society that the Ba'athist system shall continue ruling eternally.[164]

After the fall of the Assad regime in December 2024, Syria’s Constitutional Declaration in March 2025 criminalized public support for the former Assad regime.

Turkey

Republicans

Monument to Atatürk in Kadıköy, Istanbul

In Turkey, founder of the Turkish Republic Mustafa Kemal Atatürk is commemorated by a myriad of memorials throughout the country, such as the Atatürk International Airport in Istanbul, the Atatürk Bridge over the Golden Horn (Haliç), the Atatürk Dam, and Atatürk Stadium. His titles include Great Leader (Ulu Önder), Eternal Commander (Ebedî Başkomutan), Head Teacher (Başöğretmen), and Eternal Chief (Ebedî Şef). Atatürk statues have been erected in all Turkish cities by the Turkish Government, and most towns have their own memorial to him. His face and name are seen and heard everywhere in Turkey; his portrait can be seen in all public buildings, in all schools and classrooms, on all school textbooks, on all Turkish lira banknotes, and in the homes of many Turkish families.

At the exact time of Atatürk's death, on every November 10, at 09:05, most vehicles and people in the country's streets pause for one minute in remembrance. In 1951, the Turkish Parliament issued a law (5816) outlawing insults to his reminiscence (Turkish: hatırasına alenen hakaret) or destruction of objects representing him, which is still in force. There is a government website that is aimed at denouncing different kinds of crimes found on the internet, including the 8th element crimes committed against Atatürk (Turkish: Atatürk aleyhine işlenen suçlar). The Turkish government as of 2025 has filters in place to block websites deemed to contain materials insulting to his memory.

The start of Atatürk's cult of personality is placed in the 1920s, when the first statues started being built. The idea of Atatürk as the "father of the Turks" is ingrained in Turkish politics, and politicians in that country are evaluated in relation to his cult of personality. The persistence of the phenomenon of Atatürk's personality cult has become an area of deep interest to scholars. Atatürk impersonators are also seen around Turkey much after Atatürk's death to preserve what is called the "world's longest-running personality cult."

Monarchists

A wall rug of Erdoğan at a rally of his party

Ottoman sultans Mehmed the Conqueror and Abdul Hamid II have cults of personality created by religious conservatives and Islamists. The cults created for the sultans are kept alive by devout Muslims who oppose secular lifestyles and secularist ideas. Scholars have attributed a resurgence in Abdul Hamid's personality cult as an attempt to check Atatürk's established image as the founder of modern Turkey.

In recent years, there has been a growing cult of personality in Turkey around current President Recep Tayyip Erdoğan.

Turkmenistan

The rotating statue of Saparmurat Niyazov in Turkmenistan

Saparmurat Niyazov, who was President of Turkmenistan from 1985 to 2006, is another oft-cited cultivator of a cult of personality. Human Rights Watch, in its World Report 2012, said there was a cult of personality of then President Gurbanguly BerdimuhamedowAgence France-Presse, a French international news agency, reported a developing personality cult. Reporters Without Borders said the president was promoting a cult of personality around himself and that his portraits had taken the place of those of the previous president.

United Kingdom

United States

Presidents in American history who have been assessed by various historians as being supported by the effects of a cult of personality include George Washington, Thomas Jefferson, Andrew Jackson, Theodore Roosevelt, Franklin D. Roosevelt, John F. Kennedy, Ronald Reagan, and Donald Trump.

A number of statesmen in American history have been noted by various historians as being supported by the effects of a cult of personality. Among the most reified figures in American historiography are the "Founding Fathers," a group which includes figures like George Washington, Thomas Jefferson, Benjamin Franklin, Paul Revere, and others.

Other American statesmen, mostly presidents, have also been described as having personality cults, including Andrew Jackson, Theodore RooseveltFranklin D. RooseveltRonald Reagan, and Donald TrumpConrad Black, who wrote several biographies of American presidents, argued that the "supreme champion of the American personality cult" has "deservedly" been Abraham LincolnJohn F. Kennedy's cult of personality largely came about after his assassination, although he and his wife Jackie Kennedy's appearance all contributed to the aura of "Camelot," which surrounded his administration.

Another American politician to whom a cult of personality has been ascribed is Huey Long, the populist governor of Louisiana from 1928 to 1932, who continued to control the politics of the state as a United States senator until he was assassinated in 1935. The LaRouche movement has been considered to be a personality cult based upon Lyndon LaRouche. Critics of the Revolutionary Communist Party, USA have labeled it a personality cult centered around its leader, Bob Avakian.

Venezuela

Vietnam

Ho Chi Minh statue in front of the City Hall of Ho Chi Minh City

The Vietnamese Communist Party regime has continually maintained a personality cult around Ho Chi Minh since the 1950s in North Vietnam, and it was later extended to South Vietnam after reunification, which it sees as a crucial part of its propaganda campaign surrounding Ho and the Party's past.

Portrait of President Ngo Dinh Diem during a pro-government demonstration in South Vietnam

The former capital of South Vietnam, Saigon, was officially renamed Ho Chi Minh City on May 1, 1975, one day after its capture, which officially ended the Vietnam War.

Throughout the existence of South Vietnam, its government sought to build a cult of personality around its head of state, Ngo Dinh Diem, with such institutions as National Revolutionary Movement and the Ministry of Information and Youth. The South Vietnamese regime promoted a national identity centered around the personality of Ngo Dinh Diem, his ideas, and his political doctrine, carried out indoctrination activities among the Vietnamese peasantry similar to the ones of Vichy France, and presented Ngo Dinh Diem as an "enlightened sovereign" who could improve the lot of all Vietnamese by creating "economic and social stability for all."

Yugoslavia

A cult of personality was created around Yugoslav President Josip Broz Tito, imitating that of the cult of Stalin. Homage included naming towns and cities after him, inscribing the name TITO on walls and mountain slopes, and planting memorial alleys.

Business

Some senior commercial executives, following in the footsteps of the likes of heroes such as Henry Ford or Thomas J. Watson, have also become "omnipotent superstars" and the objects of cults of personality, including Elon MuskSteve JobsSam Altman, and Jeff Bezos.

Entertainment

Outside of business and politics, numerous pop culture figures have been labeled as having a cult of personality through their fandoms that has been exacerbated through social media and online communities, with Taylor Swift and her fans (known as Swifties) being labeled as a prominent example in the 21st century.

Cult of Personality is a 1988 song by Living Colour, and the group wrote it to emphasize how leaders can manipulate public opinion.

Personalized medicine

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Personalized_medicine

Personalized medicine, also referred to as precision medicine or systems medicine, is a medical model that separates people into different groups—with medical decisions, practices, interventions and/or products being tailored to the individual patient based on their predicted response or risk of disease. The terms personalized medicine, precision medicine, stratified medicine and P4 medicine are used interchangeably to describe this concept, though some authors and organizations differentiate between these expressions based on particular nuances. P4 is short for "predictive, preventive, personalized and participatory".

While the tailoring of treatment to patients dates back at least to the time of Hippocrates,  the usage of the term has risen in recent years thanks to the development of new diagnostic and informatics approaches that provide an understanding of the molecular basis of disease, particularly genomics. This provides a clear biomarker on which to stratify related patients.

Among the 14 Grand Challenges for Engineering, an initiative sponsored by National Academy of Engineering (NAE), personalized medicine has been identified as a key and prospective approach to "achieve optimal individual health decisions", therefore overcoming the challenge to "engineer better medicines".

Development of concept

In personalised medicine, diagnostic testing is often employed for selecting appropriate and optimal therapies based on the patient's genetics or their other molecular or cellular characteristics. The use of genetic information has played a major role in certain aspects of personalized medicine (e.g. pharmacogenomics), and the term was first coined in the context of genetics, though it has since broadened to encompass all sorts of personalization measures, including the use of proteomics, imaging analysis, nanoparticle-based theranostics, among others.

Difference between precision medicine and personalized medicine

Precision medicine is a medical model that proposes the customization of healthcare, with medical decisions, treatments, practices, or products being tailored to a subgroup of patients, instead of a one‐drug‐fits‐all model. In precision medicine, diagnostic testing is often employed for selecting appropriate and optimal therapies based on the context of a patient's genetic content or other molecular or cellular analysis. Tools employed in precision medicine can include molecular diagnostics, imaging, and analytics.

Precision medicine and personalized medicine (also individualized medicine) are analogous, applying a person's genetic profile to guide clinical decisions about the prevention, diagnosis, and treatment of a disease. Personalized medicine is established on discoveries from the Human Genome Project.

In explaining the distinction from the similar term of personalized medicine, the United States President's Council of Advisors on Science and Technology writes:

Precision medicine refers to the tailoring of medical treatment to the individual characteristics of each patient. It does not literally mean the creation of drugs or medical devices that are unique to a patient, but rather the ability to classify individuals into subpopulations that differ in their susceptibility to a particular disease, in the biology or prognosis of those diseases they may develop, or in their response to a specific treatment. Preventive or therapeutic interventions can then be concentrated on those who will benefit, sparing expense and side effects for those who will not.

The use of the term "precision medicine" can extend beyond treatment selection to also cover creating unique medical products for particular individuals—for example, "...patient-specific tissue or organs to tailor treatments for different people." Hence, the term in practice has so much overlap with "personalized medicine" that they are often used interchangeably, even though the latter is sometimes misinterpreted as involving a unique treatment for each individual.

Background

Basics

Every person has a unique variation of the human genome. Although most of the variation between individuals has no effect on health, an individual's health stems from genetic variation with behaviors and influences from the environment.

Modern advances in personalized medicine rely on technology that confirms a patient's fundamental biology, DNA, RNA, or protein, which ultimately leads to confirming disease. For example, personalised techniques such as genome sequencing can reveal mutations in DNA that influence diseases ranging from cystic fibrosis to cancer. Another method, called RNA-seq, can show which RNA molecules are involved with specific diseases. Unlike DNA, levels of RNA can change in response to the environment. Therefore, sequencing RNA can provide a broader understanding of a person's state of health. Recent studies have linked genetic differences between individuals to RNA expression, translation, and protein levels.

The concepts of personalised medicine can be applied to new and transformative approaches to health care. Personalised health care is based on the dynamics of systems biology and uses predictive tools to evaluate health risks and to design personalised health plans to help patients mitigate risks, prevent disease and to treat it with precision when it occurs. The concepts of personalised health care are receiving increasing acceptance with the Veterans Administration committing to personalised, proactive patient driven care for all veterans. In some instances personalised health care can be tailored to the markup of the disease causing agent instead of the patient's genetic markup; examples are drug resistant bacteria or viruses.

Precision medicine often involves the application of panomic analysis and systems biology to analyze the cause of an individual patient's disease at the molecular level and then to utilize targeted treatments (possibly in combination) to address that individual patient's disease process. The patient's response is then tracked as closely as possible, often using surrogate measures such as tumor load (versus true outcomes, such as five-year survival rate), and the treatment finely adapted to the patient's response. The branch of precision medicine that addresses cancer is referred to as "precision oncology". The field of precision medicine that is related to psychiatric disorders and mental health is called "precision psychiatry."

Inter-personal difference of molecular pathology is diverse, so as inter-personal difference in the exposome, which influence disease processes through the interactome within the tissue microenvironment, differentially from person to person. As the theoretical basis of precision medicine, the "unique disease principle" emerged to embrace the ubiquitous phenomenon of heterogeneity of disease etiology and pathogenesis. The unique disease principle was first described in neoplastic diseases as the unique tumor principle. As the exposome is a common concept of epidemiology, precision medicine is intertwined with molecular pathological epidemiology, which is capable of identifying potential biomarkers for precision medicine.

Method

In order for physicians to know if a mutation is connected to a certain disease, researchers often do a study called a "genome-wide association study" (GWA study). Such a study will look at one disease, and then sequence the genome of many patients with that particular disease to look for shared mutations in the genome. Mutations that are determined to be related to a disease by a GWA study can then be used to diagnose that disease in future patients, by looking at their genome sequence to find that same mutation. The first GWA study, conducted in 2005, studied patients with age-related macular degeneration (ARMD). It found two different mutations, each containing only a variation in only one nucleotide (called single nucleotide polymorphisms, or SNPs), which were associated with ARMD. GWA studies like this have been very successful in identifying common genetic variations associated with diseases. As of early 2014, over 1,300 GWA studies have been completed.

Disease risk assessment

Multiple genes collectively influence the likelihood of developing many common and complex diseases. Personalised medicine can also be used to predict a person's risk for a particular disease, based on one or even several genes. This approach uses the same sequencing technology to focus on the evaluation of disease risk, allowing the physician to initiate preventive treatment before the disease presents itself in their patient. For example, if it is found that a DNA mutation increases a person's risk of developing Type 2 Diabetes, this individual can begin lifestyle changes that will lessen their chances of developing Type 2 Diabetes later in life.

Practice

The ability to provide precision medicine to patients in routine clinical settings depends on the availability of molecular profiling tests, e.g. individual germline DNA sequencing. While precision medicine currently individualizes treatment mainly on the basis of genomic tests (e.g. Oncotype DX), several promising technology modalities are being developed, from techniques combining spectrometry and computational power to real-time imaging of drug effects in the body. Many different aspects of precision medicine are tested in research settings (e.g., proteome, microbiome), but in routine practice not all available inputs are used. The ability to practice precision medicine is also dependent on the knowledge bases available to assist clinicians in taking action based on test results. Early studies applying omics-based precision medicine to cohorts of individuals with undiagnosed disease has yielded a diagnosis rate ~35% with ~1 in 5 of newly diagnosed receiving recommendations regarding changes in therapy. It has been suggested that until pharmacogenetics becomes further developed and able to predict individual treatment responses, the N-of-1 trials are the best method of identifying patients responding to treatments.

On the treatment side, PM can involve the use of customized medical products such drug cocktails produced by pharmacy compounding or customized devices. It can also prevent harmful drug interactions, increase overall efficiency when prescribing medications, and reduce costs associated with healthcare.

The question of who benefits from publicly funded genomics is an important public health consideration, and attention is needed to ensure that implementation of genomic medicine does not further entrench social‐equity concerns.

Artificial intelligence in precision medicine

Artificial intelligence is providing a paradigm shift toward precision medicine. Machine learning algorithms are used for genomic sequence and to analyze and draw inferences from the vast amounts of data patients and healthcare institutions recorded in every moment. AI techniques are used in precision cardiovascular medicine to understand genotypes and phenotypes in existing diseases, improve the quality of patient care, enable cost-effectiveness, and reduce readmission and mortality rates. A 2021 paper reported that machine learning was able to predict the outcomes of Phase III clinical trials (for treatment of prostate cancer) with 76% accuracy. This suggests that clinical trial data could provide a practical source for machine learning-based tools for precision medicine.

Precision medicine may be susceptible to subtle forms of algorithmic bias. For example, the presence of multiple entry fields with values entered by multiple observers can create distortions in the ways data is understood and interpreted. A 2020 paper showed that training machine learning models in a population-specific fashion (i.e. training models specifically for Black cancer patients) can yield significantly superior performance than population-agnostic models.

Precision Medicine Initiative

In his 2015 State of the Union address, then-U.S. President Barack Obama stated his intention to give $215 million of funding to the "Precision Medicine Initiative" of the United States National Institutes of Health. A short-term goal of this initiative was to expand cancer genomics to develop better prevention and treatment methods. In the long term, the Precision Medicine Initiative aimed to build a comprehensive scientific knowledge base by creating a national network of scientists and embarking on a national cohort study of one million Americans to expand our understanding of health and disease. The mission statement of the Precision Medicine Initiative read: "To enable a new era of medicine through research, technology, and policies that empower patients, researchers, and providers to work together toward development of individualized treatments". In 2016 this initiative was renamed to "All of Us" and by January 2018, 10,000 people had enrolled in its pilot phase.

Benefits of precision medicine

Precision medicine helps health care providers better understand the many things—including environment, lifestyle, and heredity—that play a role in a patient's health, disease, or condition. This information lets them more accurately predict which treatments will be most effective and safe, or possibly how to prevent the illness from starting in the first place. In addition, benefits are to:

  • shift the emphasis in medicine from reaction to prevention
  • predict susceptibility to disease
  • improve disease detection
  • preempt disease progression
  • customize disease-prevention strategies
  • prescribe more effective drugs
  • avoid prescribing drugs with predictable negative side effects
  • reduce the time, cost, and failure rate of pharmaceutical clinical trials
  • eliminate trial-and-error inefficiencies that inflate health care costs and undermine patient care

Applications

Advances in personalised medicine will create a more unified treatment approach specific to the individual and their genome. Personalised medicine may provide better diagnoses with earlier intervention, and more efficient drug development and more targeted therapies.

Diagnosis and intervention

Having the ability to look at a patient on an individual basis will allow for a more accurate diagnosis and specific treatment plan. Genotyping is the process of obtaining an individual's DNA sequence by using biological assays. By having a detailed account of an individual's DNA sequence, their genome can then be compared to a reference genome, like that of the Human Genome Project, to assess the existing genetic variations that can account for possible diseases. A number of private companies, such as 23andMe, Navigenics, and Illumina, have created Direct-to-Consumer genome sequencing accessible to the public. Having this information from individuals can then be applied to effectively treat them. An individual's genetic make-up also plays a large role in how well they respond to a certain treatment, and therefore, knowing their genetic content can change the type of treatment they receive.

An aspect of this is pharmacogenomics, which uses an individual's genome to provide a more informed and tailored drug prescription. Often, drugs are prescribed with the idea that it will work relatively the same for everyone, but in the application of drugs, there are a number of factors that must be considered. The detailed account of genetic information from the individual will help prevent adverse events, allow for appropriate dosages, and create maximum efficacy with drug prescriptions. For instance, warfarin is the FDA approved oral anticoagulant commonly prescribed to patients with blood clots. Due to warfarin's significant interindividual variability in pharmacokinetics and pharmacodynamics, its rate of adverse events is among the highest of all commonly prescribed drugs. However, with the discovery of polymorphic variants in CYP2C9 and VKORC1 genotypes, two genes that encode the individual anticoagulant response, physicians can use patients' gene profile to prescribe optimum doses of warfarin to prevent side effects such as major bleeding and to allow sooner and better therapeutic efficacy. The pharmacogenomic process for discovery of genetic variants that predict adverse events to a specific drug has been termed toxgnostics.

An aspect of a theranostic platform applied to personalized medicine can be the use of diagnostic tests to guide therapy. The tests may involve medical imaging such as MRI contrast agents (T1 and T2 agents), fluorescent markers (organic dyes and inorganic quantum dots), and nuclear imaging agents (PET radiotracers or SPECT agents). or in vitro lab test including DNA sequencing and often involve deep learning algorithms that weigh the result of testing for several biomarkers.

In addition to specific treatment, personalised medicine can greatly aid the advancements of preventive care. For instance, many women are already being genotyped for certain mutations in the BRCA1 and BRCA2 gene if they are predisposed because of a family history of breast cancer or ovarian cancer. As more causes of diseases are mapped out according to mutations that exist within a genome, the easier they can be identified in an individual. Measures can then be taken to prevent a disease from developing. Even if mutations were found within a genome, having the details of their DNA can reduce the impact or delay the onset of certain diseases. Having the genetic content of an individual will allow better guided decisions in determining the source of the disease and thus treating it or preventing its progression. This will be extremely useful for diseases like Alzheimer's or cancers that are thought to be linked to certain mutations in our DNA.

A tool that is being used now to test efficacy and safety of a drug specific to a targeted patient group/sub-group is companion diagnostics. This technology is an assay that is developed during or after a drug is made available on the market and is helpful in enhancing the therapeutic treatment available based on the individual. These companion diagnostics have incorporated the pharmacogenomic information related to the drug into their prescription label in an effort to assist in making the most optimal treatment decision possible for the patient.

An overall process of personalized cancer therapy. Genome sequencing will allow for a more accurate and personalized drug prescription and a targeted therapy for different patients.

Drug development and usage

Having an individual's genomic information can be significant in the process of developing drugs as they await approval from the FDA for public use. Having a detailed account of an individual's genetic make-up can be a major asset in deciding if a patient can be chosen for inclusion or exclusion in the final stages of a clinical trial. Being able to identify patients who will benefit most from a clinical trial will increase the safety of patients from adverse outcomes caused by the product in testing, and will allow smaller and faster trials that lead to lower overall costs. In addition, drugs that are deemed ineffective for the larger population can gain approval by the FDA by using personal genomes to qualify the effectiveness and need for that specific drug or therapy even though it may only be needed by a small percentage of the population.

Physicians commonly use a trial and error strategy until they find the treatment therapy that is most effective for their patient. With personalized medicine, these treatments can be more specifically tailored by predicting how an individual's body will respond and if the treatment will work based on their genome. This has been summarized as "therapy with the right drug at the right dose in the right patient." Such an approach would also be more cost-effective and accurate. For instance, Tamoxifen used to be a drug commonly prescribed to women with ER+ breast cancer, but 65% of women initially taking it developed resistance. After research by people such as David Flockhart, it was discovered that women with certain mutation in their CYP2D6 gene, a gene that encodes the metabolizing enzyme, were not able to efficiently break down Tamoxifen, making it an ineffective treatment for them. Women are now genotyped for these specific mutations to select the most effective treatment.

Screening for these mutations is carried out via high-throughput screening or phenotypic screening. Several drug discovery and pharmaceutical companies are currently utilizing these technologies to not only advance the study of personalised medicine, but also to amplify genetic research. Alternative multi-target approaches to the traditional approach of "forward" transfection library screening can entail reverse transfection or chemogenomics.

Pharmacy compounding is another application of personalised medicine. Though not necessarily using genetic information, the customized production of a drug whose various properties (e.g. dose level, ingredient selection, route of administration, etc.) are selected and crafted for an individual patient is accepted as an area of personalised medicine (in contrast to mass-produced unit doses or fixed-dose combinations). Computational and mathematical approaches for predicting drug interactions are also being developed. For example, phenotypic response surfaces model the relationships between drugs, their interactions, and an individual's biomarkers.

One active area of research is efficiently delivering personalized drugs generated from pharmacy compounding to the disease sites of the body. For instance, researchers are trying to engineer nanocarriers that can precisely target the specific site by using real-time imaging and analyzing the pharmacodynamics of the drug delivery. Several candidate nanocarriers are being investigated, such as iron oxide nanoparticles, quantum dots, carbon nanotubes, gold nanoparticles, and silica nanoparticles. Alteration of surface chemistry allows these nanoparticles to be loaded with drugs, as well as to avoid the body's immune response, making nanoparticle-based theranostics possible. Nanocarriers' targeting strategies are varied according to the disease. For example, if the disease is cancer, a common approach is to identify the biomarker expressed on the surface of cancer cells and to load its associated targeting vector onto nanocarrier to achieve recognition and binding; the size scale of the nanocarriers will also be engineered to reach the enhanced permeability and retention effect (EPR) in tumor targeting. If the disease is localized in the specific organ, such as the kidney, the surface of the nanocarriers can be coated with a certain ligand that binds to the receptors inside that organ to achieve organ-targeting drug delivery and avoid non-specific uptake. Despite the great potential of this nanoparticle-based drug delivery system, the significant progress in the field is yet to be made, and the nanocarriers are still being investigated and modified to meet clinical standards.

Theranostics

Theranostics is a personalized approach in nuclear medicine, using similar molecules for both imaging (diagnosis) and therapy. The term is a portmanteau of "therapeutics" and "diagnostics". Its most common applications are attaching radionuclides (either gamma or positron emitters) to molecules for SPECT or PET imaging, or electron emitters for radiotherapy. One of the earliest examples is the use of radioactive iodine for treatment of people with thyroid cancer. Other examples include radio-labelled anti-CD20 antibodies (e.g. Bexxar) for treating lymphoma, Radium-223 for treating bone metastases, Lutetium-177 DOTATATE for treating neuroendocrine tumors and Lutetium-177 PSMA for treating prostate cancer. A commonly used reagent is fluorodeoxyglucose, using the isotope fluorine-18.

Respiratory proteomics

The preparation of a proteomics sample on a sample carrier to be analyzed by mass spectrometry

Respiratory diseases affect humanity globally, with chronic lung diseases (e.g., asthma, chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, among others) and lung cancer causing extensive morbidity and mortality. These conditions are highly heterogeneous and require an early diagnosis. However, initial symptoms are nonspecific, and the clinical diagnosis is made late frequently. Over the last few years, personalized medicine has emerged as a medical care approach that uses novel technology aiming to personalize treatments according to the particular patient's medical needs. In specific, proteomics is used to analyze a series of protein expressions, instead of a single biomarker. Proteins control the body's biological activities including health and disease, so proteomics is helpful in early diagnosis. In the case of respiratory disease, proteomics analyzes several biological samples including serum, blood cells, bronchoalveolar lavage fluids (BAL), nasal lavage fluids (NLF), sputum, among others. The identification and quantification of complete protein expression from these biological samples are conducted by mass spectrometry and advanced analytical techniques. Respiratory proteomics has made significant progress in the development of personalized medicine for supporting health care in recent years. For example, in a study conducted by Lazzari et al. in 2012, the proteomics-based approach has made substantial improvement in identifying multiple biomarkers of lung cancer that can be used in tailoring personalized treatments for individual patients. More and more studies have demonstrated the usefulness of proteomics to provide targeted therapies for respiratory disease.

Cancer genomics

Over recent decades cancer research has discovered a great deal about the genetic variety of types of cancer that appear the same in traditional pathology. There has also been increasing awareness of tumor heterogeneity, or genetic diversity within a single tumor. Among other prospects, these discoveries raise the possibility of finding that drugs that have not given good results applied to a general population of cases may yet be successful for a proportion of cases with particular genetic profiles.

Personalized oncogenomics is the application of personalized medicine to cancer genomics. High-throughput sequencing methods are used to characterize genes associated with cancer to better understand disease pathology and improve drug development. Oncogenomics is one of the most promising branches of genomics, particularly because of its implications in drug therapy. Examples of this include:

  • Trastuzumab (trade names Herclon, Herceptin) is a monoclonal antibody drug that interferes with the HER2/neu receptor. Its main use is to treat certain breast cancers. This drug is only used if a patient's cancer is tested for over-expression of the HER2/neu receptor. Two tissue-typing tests are used to screen patients for possible benefit from Herceptin treatment. The tissue tests are immunohistochemistry(IHC) and Fluorescence In Situ Hybridization(FISH). Only Her2+ patients will be treated with Herceptin therapy (trastuzumab)
  • Tyrosine kinase inhibitors such as imatinib (marketed as Gleevec) have been developed to treat chronic myeloid leukemia (CML), in which the BCR-ABL fusion gene (the product of a reciprocal translocation between chromosome 9 and chromosome 22) is present in >95% of cases and produces hyperactivated abl-driven protein signaling. These medications specifically inhibit the Ableson tyrosine kinase (ABL) protein and are thus a prime example of "rational drug design" based on knowledge of disease pathophysiology.
  • The FoundationOne CDx report produced by Foundation Medicine, which looks at genes in individual patients' tumor biopsies and recommends specific drugs
  • High mutation burden is indicative of response to immunotherapy, and also specific patterns of mutations have been associated with previous exposure to cytotoxic cancer drugs.

Population screening

Through the use of genomics (microarray), proteomics (tissue array), and imaging (fMRI, micro-CT) technologies, molecular-scale information about patients can be easily obtained. These so-called molecular biomarkers have proven powerful in disease prognosis, such as with cancer. The main three areas of cancer prediction fall under cancer recurrence, cancer susceptibility and cancer survivability. Combining molecular scale information with macro-scale clinical data, such as patients' tumor type and other risk factors, significantly improves prognosis. Consequently, given the use of molecular biomarkers, especially genomics, cancer prognosis or prediction has become very effective, especially when screening a large population. Essentially, population genomics screening can be used to identify people at risk for disease, which can assist in preventative efforts.

Genetic data can be used to construct polygenic scores, which estimate traits such as disease risk by summing the estimated effects of individual variants discovered through a GWA study. These have been used for a wide variety of conditions, such as cancer, diabetes, and coronary artery disease. Many genetic variants are associated with ancestry, and it remains a challenge to both generate accurate estimates and to decouple biologically relevant variants from those that are coincidentally associated. Estimates generated from one population do not usually transfer well to others, requiring sophisticated methods and more diverse and global data. Most studies have used data from those with European ancestry, leading to calls for more equitable genomics practices to reduce health disparities. Additionally, while polygenic scores have some predictive accuracy, their interpretations are limited to estimating an individual's percentile and translational research is needed for clinical use.

Challenges

As personalised medicine is practiced more widely, a number of challenges arise. The current approaches to intellectual property rights, reimbursement policies, patient privacy, data biases and confidentiality as well as regulatory oversight will have to be redefined and restructured to accommodate the changes personalised medicine will bring to healthcare. For instance, a survey performed in the UK concluded that 63% of UK adults are not comfortable with their personal data being used for the sake of utilizing AI in the medical field. Furthermore, the analysis of acquired diagnostic data is a recent challenge of personalized medicine and its implementation. For example, genetic data obtained from next-generation sequencing requires computer-intensive data processing prior to its analysis. In the future, adequate tools will be required to accelerate the adoption of personalised medicine to further fields of medicine, which requires the interdisciplinary cooperation of experts from specific fields of research, such as medicine, clinical oncology, biology, and artificial intelligence.

Regulatory oversight

The U.S. Food and Drug Administration (FDA) has started taking initiatives to integrate personalised medicine into their regulatory policies. In October 2013, the agency published a report entitled "Paving the Way for Personalized Medicine: FDA's role in a New Era of Medical Product Development," in which they outlined steps they would have to take to integrate genetic and biomarker information for clinical use and drug development. These included developing specific regulatory standards, research methods and reference materials. An example of the latter category they were working on is a "genomic reference library", aimed at improving quality and reliability of different sequencing platforms. A major challenge for those regulating personalized medicine is a way to demonstrate its effectiveness relative to the current standard of care. The new technology must be assessed for both clinical and cost effectiveness, and as of 2013, regulatory agencies had no standardized method.

Intellectual property rights

As with any innovation in medicine, investment and interest in personalised medicine is influenced by intellectual property rights. There has been a lot of controversy regarding patent protection for diagnostic tools, genes, and biomarkers. In June 2013, the U.S. Supreme Court ruled that natural occurring genes cannot be patented, while "synthetic DNA" that is edited or artificially- created can still be patented. The Patent Office is currently reviewing a number of issues related to patent laws for personalised medicine, such as whether "confirmatory" secondary genetic tests post initial diagnosis, can have full immunity from patent laws. Those who oppose patents argue that patents on DNA sequences are an impediment to ongoing research while proponents point to research exemption and stress that patents are necessary to entice and protect the financial investments required for commercial research and the development and advancement of services offered.

Reimbursement policies

Reimbursement policies will have to be redefined to fit the changes that personalised medicine will bring to the healthcare system. Some of the factors that should be considered are the level of efficacy of various genetic tests in the general population, cost-effectiveness relative to benefits, how to deal with payment systems for extremely rare conditions, and how to redefine the insurance concept of "shared risk" to incorporate the effect of the newer concept of "individual risk factors". The study, Barriers to the Use of Personalized Medicine in Breast Cancer, took two different diagnostic tests which are BRACAnalysis and Oncotype DX. These tests have over ten-day turnaround times which results in the tests failing and delays in treatments. Patients are not being reimbursed for these delays which results in tests not being ordered. Ultimately, this leads to patients having to pay out-of-pocket for treatments because insurance companies do not want to accept the risks involved.

Patient privacy and confidentiality

Perhaps the most critical issue with the commercialization of personalised medicine is the protection of patients. One of the largest issues is the fear and potential consequences for patients who are predisposed after genetic testing or found to be non-responsive towards certain treatments. This includes the psychological effects on patients due to genetic testing results. The right of family members who do not directly consent is another issue, considering that genetic predispositions and risks are inheritable. The implications for certain ethnic groups and presence of a common allele would also have to be considered.

Moreover, we could refer to the privacy issue at all layers of personalized medicine from discovery to treatment. One of the leading issues is the consent of the patients to have their information used in genetic testing algorithms primarily AI algorithms. The consent of the institution who is providing the data to be used is of prominent concern as well. In 2008, the Genetic Information Nondiscrimination Act (GINA) was passed in an effort to minimize the fear of patients participating in genetic research by ensuring that their genetic information will not be misused by employers or insurers. On February 19, 2015, FDA issued a press release titled: "FDA permits marketing of first direct-to-consumer genetic carrier test for Bloom syndrome.

Data biases

Data biases also play an integral role in personalized medicine. It is important to ensure that the sample of genes being tested come from different populations. This is to ensure that the samples do not exhibit the same human biases we use in decision making.

Consequently, if the designed algorithms for personalized medicine are biased, then the outcome of the algorithm will also be biased because of the lack of genetic testing in certain populations. For instance, the results from the Framingham Heart Study have led to biased outcomes of predicting the risk of cardiovascular disease. This is because the sample was tested only on white people and when applied to the non-white population, the results were biased with overestimation and underestimation risks of cardiovascular disease.

Implementation

Several issues must be addressed before personalized medicine can be implemented. Very little of the human genome has been analyzed, and even if healthcare providers had access to a patient's full genetic information, very little of it could be effectively leveraged into treatment. Challenges also arise when processing such large amounts of genetic data. Even with error rates as low as 1 per 100 kilobases, processing a human genome could have roughly 30,000 errors. This many errors, especially when trying to identify specific markers, can make discoveries and verifiability difficult. There are methods to overcome this, but they are computationally taxing and expensive. There are also issues from an effectiveness standpoint, as after the genome has been processed, function in the variations among genomes must be analyzed using genome-wide studies. While the impact of the SNPs discovered in these kinds of studies can be predicted, more work must be done to control for the vast amounts of variation that can occur because of the size of the genome being studied. In order to effectively move forward in this area, steps must be taken to ensure the data being analyzed is good, and a wider view must be taken in terms of analyzing multiple SNPs for a phenotype. The most pressing issue that the implementation of personalized medicine is to apply the results of genetic mapping to improve the healthcare system. This is not only due to the infrastructure and technology required for a centralized database of genome data, but also the physicians that would have access to these tools would likely be unable to fully take advantage of them. In order to truly implement a personalized medicine healthcare system, there must be an end-to-end change.

The Copenhagen Institute for Futures Studies and Roche set up FutureProofing Healthcare which produces a Personalised Health Index, rating different countries performance against 27 different indicators of personalised health across four categories called 'Vital Signs'. They have run conferences in many countries to examine their findings.

Systems medicine

Systems medicine is an interdisciplinary field of study that looks at the systems of the human body as part of an integrated whole, incorporating biochemical, physiological, and environment interactions. Systems medicine draws on systems science and systems biology, and considers complex interactions within the human body in light of a patient's genomics, behavior and environment.

The earliest uses of the term systems medicine appeared in 1992, in an article on systems medicine and pharmacology by T. Kamada.

An important topic in systems medicine and systems biomedicine is the development of computational models that describe disease progression and the effect of therapeutic interventions.

More recent approaches include the redefinition of disease phenotypes based on common mechanisms rather than symptoms. These provide then therapeutic targets including network pharmacology and drug repurposing. Since 2018, there is a dedicated scientific journal, Systems Medicine.

Fundamental schools of systems medicine

Essentially, the issues dealt with by systems medicine can be addressed in two basic ways, molecular (MSM) and organismal systems medicine (OSM):

Molecular systems medicine (MSM)

This approach relies on omics technologies (genomics, proteomics, transcriptomics, phenomics, metabolomics etc.) and tries to understand physiological processes and the evolution of disease in a bottom-up strategy, i.e. by simulating, synthesising and integrating the description of molecular processes to deliver an explanation of an organ system or even the organism in its whole.

Organismal systems medicine (OSM)

This branch of systems medicine, going back to the traditions of Ludwig von Bertalanffy's systems theory and biological cybernetics is a top-down strategy that starts with the description of large, complex processing structures (i.e. neural networks, feedback loops and other motifs) and tries to find sufficient and necessary conditions for the corresponding functional organisation on a molecular level.

A common challenge for both schools is the translation between the molecular and the organismal level. This can be achieved e.g. by affine subspace mapping and sensitivity analysis, but also requires some preparative steps on both ends of the epistemic gap.

Drake equation

From Wikipedia, the free encyclopedia https://en.wikipedia.org/wiki/Drake_equation   Frank Drake ...