GET https://rct.dev.bbntimes.com/science/personalizing-medicine-past-reductionism

Response
200 OK
IP
216.73.216.222
Profiled on
Token
549bb8

ArticleController :: show

Request

GET Parameters

None

POST Parameters

None

Uploaded Files

None

Request Attributes

Key Value
_controller 
"App\Controller\ArticleController::show"
_firewall_context 
"security.firewall.map.context.main"
_links 
Symfony\Component\WebLink\GenericLinkProvider {#3615
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    3733 => Symfony\Component\WebLink\Link {#3733
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      -rel: [
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    3732 => Symfony\Component\WebLink\Link {#3732
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    3730 => Symfony\Component\WebLink\Link {#3730
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      ]
      -attributes: [
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    }
    3729 => Symfony\Component\WebLink\Link {#3729
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      -rel: [
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      -attributes: [
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      ]
    }
    3728 => Symfony\Component\WebLink\Link {#3728
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      -rel: [
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      -attributes: [
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    3726 => Symfony\Component\WebLink\Link {#3726
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      ]
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    3725 => Symfony\Component\WebLink\Link {#3725
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      -attributes: [
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      -attributes: [
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    3723 => Symfony\Component\WebLink\Link {#3723
      -href: "/build/comment-css.css"
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      -attributes: [
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}
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"article_show"
_route_params 
[
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]
_security_firewall_run 
"_security_main"
_stopwatch_token 
"9c0fa1"
category 
"science"
slug 
"personalizing-medicine-past-reductionism"

Request Headers

Header Value
accept 
"*/*"
accept-encoding 
"gzip, br, zstd, deflate"
connection 
"close"
cookie 
"PHPSESSID=96mn190ija3e0d7iec2f9gcp90"
host 
"rct.dev.bbntimes.com"
user-agent 
"Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)"
x-php-ob-level 
"1"

Request Content

Request content not available (it was retrieved as a resource).

Response

Response Headers

Header Value
cache-control 
"no-cache, private"
content-type 
"text/html; charset=UTF-8"
date 
"Sat, 31 May 2025 02:43:18 GMT"
link 
"</build/runtime.js>; rel="preload"; as="script",</build/644.js>; rel="preload"; as="script",</build/502.js>; rel="preload"; as="script",</build/app.js>; rel="preload"; as="script",</build/view-more.js>; rel="preload"; as="script",</build/term-condition.js>; rel="preload"; as="script",</build/contact.js>; rel="preload"; as="script",</build/scroll-infinite-article.js>; rel="preload"; as="script",</build/app.css>; rel="preload"; as="style",</build/cookie-style.css>; rel="preload"; as="style",</build/term-condition-css.css>; rel="preload"; as="style",</build/contact-css.css>; rel="preload"; as="style",</build/comment-css.css>; rel="preload"; as="style""
x-debug-token 
"549bb8"

Cookies

Request Cookies

Key Value
PHPSESSID 
"96mn190ija3e0d7iec2f9gcp90"

Response Cookies

No response cookies

Session 6

Session Metadata

Key Value
Created 
"Sat, 31 May 25 02:41:44 +0000"
Last used 
"Sat, 31 May 25 02:43:16 +0000"
Lifetime 
0

Session Attributes

Attribute Value
_csrf/https-comment 
"6wJplswcrgVAj5EVVJ6g5dqb7JG3uLXLihbsKSKNC8c"
_csrf/https-cookie_accept 
"ghx9jeeZ-l8pfg7g8tY4uF0ZVNbVeohiSH8QjqvHQnM"

Session Usage

6 Usages
Stateless check enabled
Usage
Symfony\Component\Security\Csrf\TokenStorage\SessionTokenStorage:76
Show trace 
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Symfony\Component\Security\Csrf\TokenStorage\SessionTokenStorage:79
Show trace 
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Symfony\Component\Security\Csrf\TokenStorage\SessionTokenStorage:52
Show trace 
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Symfony\Component\Security\Csrf\TokenStorage\SessionTokenStorage:56
Show trace 
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    "type" => "->"
  ]
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    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpKernel.php"
    "line" => 76
    "function" => "handleRaw"
    "class" => "Symfony\Component\HttpKernel\HttpKernel"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/Kernel.php"
    "line" => 197
    "function" => "handle"
    "class" => "Symfony\Component\HttpKernel\HttpKernel"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/runtime/Runner/Symfony/HttpKernelRunner.php"
    "line" => 35
    "function" => "handle"
    "class" => "Symfony\Component\HttpKernel\Kernel"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/autoload_runtime.php"
    "line" => 29
    "function" => "run"
    "class" => "Symfony\Component\Runtime\Runner\Symfony\HttpKernelRunner"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/public/index.php"
    "line" => 5
    "args" => [
      "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/autoload_runtime.php"
    ]
    "function" => "require_once"
  ]
]
Symfony\Component\Security\Core\Authentication\Token\Storage\UsageTrackingTokenStorage:41
Show trace 
[
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/security-core/Authentication/Token/Storage/UsageTrackingTokenStorage.php"
    "line" => 41
    "function" => "getMetadataBag"
    "class" => "Symfony\Component\HttpFoundation\Session\Session"
    "type" => "->"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/twig-bridge/AppVariable.php"
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    "function" => "getToken"
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    "function" => "twig_get_attribute"
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    "function" => "displayWithErrorHandling"
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    "function" => "render"
    "class" => "Twig\Template"
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    "line" => 280
    "function" => "render"
    "class" => "Twig\TemplateWrapper"
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    "line" => 448
    "function" => "render"
    "class" => "Twig\Environment"
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    "line" => 453
    "function" => "doRenderView"
    "class" => "Symfony\Bundle\FrameworkBundle\Controller\AbstractController"
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    "line" => 253
    "function" => "doRender"
    "class" => "Symfony\Bundle\FrameworkBundle\Controller\AbstractController"
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  [
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    "function" => "render"
    "class" => "Symfony\Bundle\FrameworkBundle\Controller\AbstractController"
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    "line" => 181
    "function" => "renderHeader"
    "class" => "App\Controller\AppController"
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  ]
  [
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    "line" => 76
    "function" => "handleRaw"
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  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpCache/SubRequestHandler.php"
    "line" => 86
    "function" => "handle"
    "class" => "Symfony\Component\HttpKernel\HttpKernel"
    "type" => "->"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/Fragment/InlineFragmentRenderer.php"
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    "function" => "handle"
    "class" => "Symfony\Component\HttpKernel\HttpCache\SubRequestHandler"
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  [
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    "function" => "render"
    "class" => "Symfony\Component\HttpKernel\Fragment\FragmentHandler"
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  [
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    "function" => "render"
    "class" => "Symfony\Component\HttpKernel\DependencyInjection\LazyLoadingFragmentHandler"
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  [
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    "function" => "block_header"
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  [
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    "function" => "displayBlock"
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    "function" => "displayWithErrorHandling"
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  [
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    "function" => "display"
    "class" => "Twig\Template"
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    "line" => 394
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    "class" => "__TwigTemplate_3ce0324a396de697d1fad9fabd68df72"
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    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/twig/twig/src/Template.php"
    "line" => 367
    "function" => "displayWithErrorHandling"
    "class" => "Twig\Template"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/twig/twig/src/Template.php"
    "line" => 379
    "function" => "display"
    "class" => "Twig\Template"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/twig/twig/src/TemplateWrapper.php"
    "line" => 38
    "function" => "render"
    "class" => "Twig\Template"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/twig/twig/src/Environment.php"
    "line" => 280
    "function" => "render"
    "class" => "Twig\TemplateWrapper"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/framework-bundle/Controller/AbstractController.php"
    "line" => 448
    "function" => "render"
    "class" => "Twig\Environment"
    "type" => "->"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/framework-bundle/Controller/AbstractController.php"
    "line" => 453
    "function" => "doRenderView"
    "class" => "Symfony\Bundle\FrameworkBundle\Controller\AbstractController"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/framework-bundle/Controller/AbstractController.php"
    "line" => 253
    "function" => "doRender"
    "class" => "Symfony\Bundle\FrameworkBundle\Controller\AbstractController"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/src/Controller/ArticleController.php"
    "line" => 277
    "function" => "render"
    "class" => "Symfony\Bundle\FrameworkBundle\Controller\AbstractController"
    "type" => "->"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpKernel.php"
    "line" => 181
    "function" => "show"
    "class" => "App\Controller\ArticleController"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpKernel.php"
    "line" => 76
    "function" => "handleRaw"
    "class" => "Symfony\Component\HttpKernel\HttpKernel"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/Kernel.php"
    "line" => 197
    "function" => "handle"
    "class" => "Symfony\Component\HttpKernel\HttpKernel"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/runtime/Runner/Symfony/HttpKernelRunner.php"
    "line" => 35
    "function" => "handle"
    "class" => "Symfony\Component\HttpKernel\Kernel"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/autoload_runtime.php"
    "line" => 29
    "function" => "run"
    "class" => "Symfony\Component\Runtime\Runner\Symfony\HttpKernelRunner"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/public/index.php"
    "line" => 5
    "args" => [
      "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/autoload_runtime.php"
    ]
    "function" => "require_once"
  ]
]
Symfony\Component\Security\Http\Firewall\ContextListener:171
Show trace 
[
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/security-http/Firewall/ContextListener.php"
    "line" => 171
    "function" => "remove"
    "class" => "Symfony\Component\HttpFoundation\Session\Session"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/event-dispatcher/Debug/WrappedListener.php"
    "line" => 116
    "function" => "onKernelResponse"
    "class" => "Symfony\Component\Security\Http\Firewall\ContextListener"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/event-dispatcher/EventDispatcher.php"
    "line" => 220
    "function" => "__invoke"
    "class" => "Symfony\Component\EventDispatcher\Debug\WrappedListener"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/event-dispatcher/EventDispatcher.php"
    "line" => 56
    "function" => "callListeners"
    "class" => "Symfony\Component\EventDispatcher\EventDispatcher"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/event-dispatcher/Debug/TraceableEventDispatcher.php"
    "line" => 139
    "function" => "dispatch"
    "class" => "Symfony\Component\EventDispatcher\EventDispatcher"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpKernel.php"
    "line" => 214
    "function" => "dispatch"
    "class" => "Symfony\Component\EventDispatcher\Debug\TraceableEventDispatcher"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpKernel.php"
    "line" => 202
    "function" => "filterResponse"
    "class" => "Symfony\Component\HttpKernel\HttpKernel"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpKernel.php"
    "line" => 76
    "function" => "handleRaw"
    "class" => "Symfony\Component\HttpKernel\HttpKernel"
    "type" => "->"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/Kernel.php"
    "line" => 197
    "function" => "handle"
    "class" => "Symfony\Component\HttpKernel\HttpKernel"
    "type" => "->"
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    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/runtime/Runner/Symfony/HttpKernelRunner.php"
    "line" => 35
    "function" => "handle"
    "class" => "Symfony\Component\HttpKernel\Kernel"
    "type" => "->"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/autoload_runtime.php"
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    "function" => "run"
    "class" => "Symfony\Component\Runtime\Runner\Symfony\HttpKernelRunner"
    "type" => "->"
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  [
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    "line" => 5
    "args" => [
      "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/autoload_runtime.php"
    ]
    "function" => "require_once"
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]

Flashes

Flashes

No flash messages were created.

Server Parameters

Server Parameters

Defined in .env

Key Value
APP_ENV 
"dev"
APP_SECRET 
"0a988e63f011514eaabfc650b599af4d"
CORS_ALLOW_ORIGIN 
"*"
DATABASE_URL 
"mysql://bbndb_rctuser:33F5W25z40or0f7@localhost:3306/rct_bbntimes"
GOOGLE_RECAPTCHA_SECRET_KEY 
"6LdV5fgpAAAAANxzTG8ZMfIjil1wu-1vrQvnUt-x"
GOOGLE_RECAPTCHA_SITE_KEY 
"6LdV5fgpAAAAAENKcn73MJAhQrbtQeqgyC4wDLMP"
MAILER_DSN 
"smtp://no-reply%40rct.dev.bbntimes.com:Bl6%26gLD48%26Of919@rct.dev.bbntimes.com:465"
MARIADB_PASSWORD 
"i!87pK&!85ezc8"

Defined as regular env variables

Key Value
APP_DEBUG 
"1"
BASE 
"/public"
CONTEXT_DOCUMENT_ROOT 
"/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com"
CONTEXT_PREFIX 
""
DOCUMENT_ROOT 
"/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com"
FCGI_ROLE 
"RESPONDER"
GATEWAY_INTERFACE 
"CGI/1.1"
HTTPS 
"on"
HTTP_ACCEPT 
"*/*"
HTTP_ACCEPT_ENCODING 
"gzip, br, zstd, deflate"
HTTP_CONNECTION 
"close"
HTTP_COOKIE 
"PHPSESSID=96mn190ija3e0d7iec2f9gcp90"
HTTP_HOST 
"rct.dev.bbntimes.com"
HTTP_USER_AGENT 
"Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)"
PASSENGER_COMPILE_NATIVE_SUPPORT_BINARY 
"0"
PASSENGER_DOWNLOAD_NATIVE_SUPPORT_BINARY 
"0"
PATH 
"/usr/local/sbin:/usr/local/bin:/usr/sbin:/usr/bin:/sbin:/bin:/snap/bin"
PHP_SELF 
"/public/index.php"
PP_CUSTOM_PHP_CGI_INDEX 
"plesk-php81-fastcgi"
PP_CUSTOM_PHP_INI 
"/var/www/vhosts/system/rct.dev.bbntimes.com/etc/php.ini"
QUERY_STRING 
""
REDIRECT_BASE 
"/public"
REDIRECT_HTTPS 
"on"
REDIRECT_PASSENGER_COMPILE_NATIVE_SUPPORT_BINARY 
"0"
REDIRECT_PASSENGER_DOWNLOAD_NATIVE_SUPPORT_BINARY 
"0"
REDIRECT_REDIRECT_HTTPS 
"on"
REDIRECT_REDIRECT_PASSENGER_COMPILE_NATIVE_SUPPORT_BINARY 
"0"
REDIRECT_REDIRECT_PASSENGER_DOWNLOAD_NATIVE_SUPPORT_BINARY 
"0"
REDIRECT_REDIRECT_SCRIPT_URI 
"https://rct.dev.bbntimes.com/science/personalizing-medicine-past-reductionism"
REDIRECT_REDIRECT_SCRIPT_URL 
"/science/personalizing-medicine-past-reductionism"
REDIRECT_REDIRECT_SSL_TLS_SNI 
"rct.dev.bbntimes.com"
REDIRECT_REDIRECT_STATUS 
"200"
REDIRECT_REDIRECT_UNIQUE_ID 
"aDpsxX9bcoq1GptgowUgvgAAAIY"
REDIRECT_SCRIPT_URI 
"https://rct.dev.bbntimes.com/science/personalizing-medicine-past-reductionism"
REDIRECT_SCRIPT_URL 
"/science/personalizing-medicine-past-reductionism"
REDIRECT_SSL_TLS_SNI 
"rct.dev.bbntimes.com"
REDIRECT_STATUS 
"200"
REDIRECT_UNIQUE_ID 
"aDpsxX9bcoq1GptgowUgvgAAAIY"
REDIRECT_URL 
"/public/science/personalizing-medicine-past-reductionism"
REMOTE_ADDR 
"216.73.216.222"
REMOTE_PORT 
"17174"
REQUEST_METHOD 
"GET"
REQUEST_SCHEME 
"https"
REQUEST_TIME 
1748659397
REQUEST_TIME_FLOAT 
1748659397.7918
REQUEST_URI 
"/science/personalizing-medicine-past-reductionism"
SCRIPT_FILENAME 
"/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/public/index.php"
SCRIPT_NAME 
"/public/index.php"
SCRIPT_URI 
"https://rct.dev.bbntimes.com/science/personalizing-medicine-past-reductionism"
SCRIPT_URL 
"/science/personalizing-medicine-past-reductionism"
SERVER_ADDR 
"5.196.1.209"
SERVER_ADMIN 
"[no address given]"
SERVER_NAME 
"rct.dev.bbntimes.com"
SERVER_PORT 
"443"
SERVER_PROTOCOL 
"HTTP/1.1"
SERVER_SIGNATURE 
"<address>Apache Server at rct.dev.bbntimes.com Port 443</address>\n"
SERVER_SOFTWARE 
"Apache"
SSL_TLS_SNI 
"rct.dev.bbntimes.com"
SYMFONY_DOTENV_VARS 
"APP_ENV,APP_SECRET,DATABASE_URL,MARIADB_PASSWORD,CORS_ALLOW_ORIGIN,MAILER_DSN,GOOGLE_RECAPTCHA_SECRET_KEY,GOOGLE_RECAPTCHA_SITE_KEY"
UNIQUE_ID 
"aDpsxX9bcoq1GptgowUgvgAAAIY"

Sub Requests 6

CookieController :: renderAnalysis (token = 136ebb)

Key Value
_controller 
"App\Controller\CookieController::renderAnalysis"
_format 
"html"
_locale 
"en"
_stopwatch_token 
"eb18ce"

AppController :: renderHeader (token = fd3cb4)

Key Value
_controller 
"App\Controller\AppController::renderHeader"
_format 
"html"
_locale 
"en"
_stopwatch_token 
"e534b8"
slug 
"home"

ArticleController :: trendingArticle (token = c88b59)

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ArticleController :: relatedArticles (token = 6b21f1)

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App\Entity\Article {#1094
  -id: 1550
  -title: "Personalizing Medicine, Past Reductionism"
  -slug: "personalizing-medicine-past-reductionism"
  -introtext: "<p>Personalizing medicine is among the salient themes of modern advance, and clearly among the more widely captivating.&nbsp;President Obama emphasized “precision medicine,” effectively the same thing, as a priority for the nation in the context of the&nbsp;<a href="https://www.linkedin.com/pulse/teach-us-treasure-bird-hand-l-katz-md-mph-facpm-facp-faclm/?trk=mp-reader-card" target="_blank" rel="noopener">cancer moonshot</a>&nbsp;he endorsed in his&nbsp;State of the Union Address&nbsp;in 2016.&nbsp;In the past year, two radical cancer treatment advances have been announced,&nbsp;<a href="https://www.nytimes.com/2017/07/12/health/fda-novartis-leukemia-gene-medicine.html?action=click&amp;contentCollection=Health&amp;module=RelatedCoverage&amp;region=EndOfArticle&amp;pgtype=article" target="_blank" rel="nofollow noopener">one for leukemia</a>,&nbsp;<a href="https://www.nytimes.com/2017/10/18/health/immunotherapy-cancer-kite.html?emc=edit_th_20171019&amp;nl=todaysheadlines&amp;nlid=31395866&amp;_r=0" target="_blank" rel="nofollow noopener">one for lymphoma</a>, both involving the genetic re-engineering of a patient’s own cells into customized chemotherapy.</p>\r\n"
  -content: """
    \r\n
    <p>Along with such progress at the far frontier of biomedical science, personalization has been widely adopted into the modern ethos of medicine.&nbsp;Functional Medicine, an approach with both its fans and&nbsp;<a href="https://sciencebasedmedicine.org/functional-medicine-the-ultimate-misnomer-in-the-world-of-integrative-medicine/" target="_blank" rel="nofollow noopener">detractors</a>, was much propelled into the mainstream when the&nbsp;<a href="http://www.cleveland.com/healthfit/index.ssf/2014/09/cleveland_clinic_to_open_cente.html" target="_blank" rel="nofollow noopener">Cleveland Clinic</a>&nbsp;embraced it in 2014.&nbsp;Whatever it winds up being in the hands of a given practitioner, at its origins this field,&nbsp;<a href="http://healthcareinstituteforclinicalnutrition.com/peer-to-peer/the-history-and-future-of-functional-medicine-dr-kara-fitzgerald-and-dr-jeff-bland/" target="_blank" rel="nofollow noopener">introduced by biochemist Jeffrey Bland, PhD</a>, in the early 1990s, was about using detailed insights regarding a given patient’s metabolic profile to customize care and treat disease nearer to its&nbsp;unique-to-you&nbsp;causes.</p>\r\n
    <p>Both the methods of customization and the&nbsp;<a href="https://farewell.io/" target="_blank" rel="nofollow noopener">means of delivering care</a>&nbsp;have evolved considerably since those early days.&nbsp;Personalization at first relied much on what was called&nbsp;<a href="http://www.nature.com/nature/journal/v540/n7631/full/540153a.html" target="_blank" rel="nofollow noopener">metabolomics</a>, and at times&nbsp;proteomics&nbsp;(or proteinomics), collectively an effort to use assays of metabolites and proteins to create a personalized patient profile.&nbsp;The basic idea was that the identification of such “products” in blood could be traced back to their biochemical assembly lines, thus illuminating any aberrations there.&nbsp;Those, in turn, could (in theory) be targeted with drugs, or more often, nutrient supplements and lifestyle interventions, to restore native balance to the body’s protein factories.</p>\r\n
    <p>Since the&nbsp;<a href="https://www.nature.com/scitable/topicpage/sequencing-human-genome-the-contributions-of-francis-686" target="_blank" rel="nofollow noopener">sequencing of the full human genome</a>&nbsp;in 2003, there has been an opportunity to look beyond the protein products of genes to the genes themselves.&nbsp;While excitement for the idea that “<a href="https://www.huffingtonpost.com/david-katz-md/dna-is-not-destiny-well-d_b_8829838.html" target="_blank" rel="nofollow noopener">DNA is destiny</a>” from the early days of the genomic era has&nbsp;<a href="https://www.huffingtonpost.com/david-katz-md/nature-nurture-fate_b_681732.html" target="_blank" rel="nofollow noopener">abated with good reason</a>, general enthusiasm for genomic customization has not.&nbsp;</p>\r\n
    <p>There are at least two popular applications of genomics for therapeutic refinement:&nbsp;<a href="https://ghr.nlm.nih.gov/primer/genomicresearch/pharmacogenomics" target="_blank" rel="nofollow noopener">pharmacogenomics</a>, and&nbsp;<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2137135/" target="_blank" rel="nofollow noopener">nutrigenomics</a>.&nbsp;The latter involves identifying genetic variation, usually in the form of what are called SNPs (pronounced “snips”), which can be used to predict variable responses to diets, foods, and nutrients.&nbsp;</p>\r\n
    <p>As an example, a study by colleagues at Stanford University showed that weight loss was roughly comparable for groups of people assigned to&nbsp;<a href="https://www.ncbi.nlm.nih.gov/pubmed/17341711" target="_blank" rel="nofollow noopener">distinctly different diets</a>.&nbsp;Whereas that would have been the answer in the past, it was just the question in the genomic age: why do some people do well, and others poorly, on each of these diet assignments?&nbsp;Can genomic profiling be used to determine who is most likely to succeed on a specific diet?&nbsp;That work is&nbsp;<a href="https://www.ncbi.nlm.nih.gov/pubmed/28027950" target="_blank" rel="nofollow noopener">now on going</a>.</p>\r\n
    <p>Given our endless public preoccupation with all things diet, and perhaps especially our seemingly irrepressible hope for magical, effortless means to lose weight (and find health, generally a lesser priority), it is perhaps unsurprising that market forces have invaded the nutrigenomic domain.&nbsp;While these are still very early days in terms of the research, large sums are already being invested, and claims being made about customized dietary assignments that almost certainly put&nbsp;<a href="https://www.forbes.com/sites/davidkatz/2016/11/25/campbells-cash-and-customizing-diets-the-habit-of-hype/#2f45ca6922f5" target="_blank" rel="nofollow noopener">marketing way ahead of the science</a>.</p>\r\n
    <p>Even as enthusiasm for genomic personalization advances, other means of medical customization are emerging.&nbsp;A fascinating&nbsp;<a href="https://www.ncbi.nlm.nih.gov/pubmed/26590418" target="_blank" rel="nofollow noopener">study in&nbsp;Cell&nbsp;in 2015</a>&nbsp;showed varying glycemic responses to the same foods by individuals with differing microbiomes- and a company to customize dietary recommendations based on&nbsp;microbiomics&nbsp;has&nbsp;<a href="https://www.daytwo.com/" target="_blank" rel="nofollow noopener">already been established</a>.&nbsp;The influence of the epigenome, the bulk of our chromosomal real estate responsible for determining what our genes actually do, is known to&nbsp;<a href="https://www.verywell.com/effects-of-pregnancy-on-future-health-4066947" target="_blank" rel="nofollow noopener">reverberate across generations</a>; and has been shown to be&nbsp;<a href="https://www.ncbi.nlm.nih.gov/pubmed/18559852" target="_blank" rel="nofollow noopener">malleable in ways genes are not</a>.&nbsp;<a href="https://www.futuremedicine.com/journal/epi" target="_blank" rel="nofollow noopener">Epigenomics</a>&nbsp;thus figures among the next “big things.”</p>\r\n
    <p>While there is great promise in the application of all such “omics” based advances to personalizing medicine, I am left with a concern.&nbsp;There is nothing new or futuristic about my concern; it is, in fact,&nbsp;<a href="http://www.constitution.org/col/blind_men.htm" target="_blank" rel="nofollow noopener">time-honored</a>.&nbsp;</p>\r\n
    <p>With science driven forward by the view through a microscope, I worry that we may personalize medicine while overlooking the person.&nbsp;Those famous blind men examining the elephant in its isolated parts are a precautionary tale about the liabilities of&nbsp;<a href="https://www.huffingtonpost.com/david-katz-md/huffpost-qa-david-katz_b_2473574.html" target="_blank" rel="nofollow noopener">reductionism</a>&nbsp;run amok.</p>\r\n
    <p>I have a remedy in mind, and have coined the term “hierarchical personalization” to characterize it.&nbsp;In case it catches on, remember you heard it here first.</p>\r\n
    <p>First, we cannot personalize care for genes and intestinal microbes, and leave out the person.&nbsp;So, the first tier of hierarchical personalization is&nbsp;holistic.&nbsp;I have the&nbsp;<a href="http://www.truehealthinitiative.org/" target="_blank" rel="nofollow noopener">6 key domains of importance to lifestyle medicine</a>&nbsp;in mind: social connections and relationships; stress and mental health; sleep; toxic exposures (substances, chronic pain, harsh environments at work or home, etc.); physical activity; and dietary pattern.&nbsp;Fundamentally, we can’t hope to personalize care without knowing who a person is, in the context of their life.</p>\r\n
    <p>Second, there is&nbsp;sequential&nbsp;personalization.&nbsp;This is how&nbsp;<a href="https://www.huffingtonpost.com/david-katz-md/holism-helicopters-spiral_b_828643.html" target="_blank" rel="nofollow noopener">holistic care can go from platitude to method</a>.&nbsp;Perhaps someone wants to improve their diet and lose weight- but they have severe chronic pain, or terrible insomnia, or a toxic marriage.&nbsp;Personalization means figuring out what actually needs attention first so that the wherewithal to address the next goal, and the next is cultivated.&nbsp;The ascent to vitality does not involve a helicopter ride; it is made step by step, up a spiral stair.</p>\r\n
    <p>Then, I think, and only then, can all of the actual and potential power of various “omics” be applied to personalize the best approach to relieving pain or stress, to improving sleep or diet.&nbsp;We can call this final tier&nbsp;specific&nbsp;personalization, as it contributes potential insights to domain-specific therapeutic approaches.</p>\r\n
    <p>I fully appreciate the potential power, much of it still inchoate, of personalized medicine.&nbsp;But I know the perils of reductionism, too.&nbsp;Diverse approaches to personalizing medicine will only improve care if attention is not unduly diverted to the parts of parts- and away from the person in the room.</p>
    """
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AppController :: renderFooter (token = 93acfc)

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CookieController :: renderCookie (token = aeac85)

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"App\Controller\CookieController::renderCookie"
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