From a drop to the ocean: an immersion in individualized medicine

There are currently approximately one hundred biomarkers used in clinical practice, very few (a drop in the ocean) in comparison with the large numbers acclaimed in more than 150,000 scientific papers; intriguingly, most of these promising biomarkers will never become part of routine clinical practice. The ability of high throughput proteomics, metabolomics and other 'omics' platforms to profile a large number of analytes in a single array is increasing the complexity of biomarker validation. This innovation calls for global re-thinking of the role of clinical pathologists in transforming experimental data into clinically available tests. It has become more and more clear that health and disease can only be studied in an outstanding way by using complex systems such as integrative systems biology, systems medicine, and network medicine. In particular metabolomics will contribute to guiding the medicine of the past, towards the medicine of the present and the medicine of the future and perhaps will actually contribute to unveil many mysteries of medicine. The dynamic range of the metabolome is revealed by subjecting the organism to physiological and pathological changes in the state of health: this means that we are quite different from each other and these differences are accentuated when faced with changes, especially if very significant and/or extreme, for example, in cases of fasting or asphyxia. Indeed, in the next few years we will witness a profound change in medicine and healthcare as a result of progresses in technology and the ability to analyze large amounts of data from single patients (Big Data). Only by being aware of complexity and biological variability, by improving our knowledge, by feeding and treating different individuals in different ways, and most of all by better defining the state of health of each individual and his/her resilience, will medicine be in a position to respond in a personalized and customized way (and not approximately and epidemiologically) to the problems of human health. Proceedings of the 9 th International Workshop on Neonatology · Cagliari (Italy) · October 23 rd -26 th , 2013 · Learned lessons, changing practice and cutting-edge research