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In
the news ...
Enthusiasm
for personalized medicine premature
The increasing focus on personalized or 'precision'
medicine is misguided, distracting from broader
investments to reduce health inequities and address the
social factors that affect population health.
"There is
now broad consensus that health differences between
groups and within groups are not driven by clinical
care, but by social-structural factors that shape our
lives," write Sandro Galea, MD, DrPH, dean of the
Boston University School of Public Health, and Ronald
Bayer, PhD, professor of Sociomedical Sciences and
co-director of the Center for the History and Ethics of
Public Health at Columbia University's Mailman School of
Public Health. "Yet seemingly willfully blind to this
evidence, the United States continues to spend its
health dollars overwhelmingly on clinical care."
"It is therefore not surprising that even as we far
outpace all other countries in spending on health, we
have poorer health indicators than many countries, some
of them far less wealthy than ours."
Bayer and Galea
say that while investments in precision medicine may
ultimately "open new vistas of science" and make
contributions to "a narrow set of conditions that are
primarily genetically determined," enthusiasm about the
promise of this research is premature.
"Without
minimizing the possible gains to clinical care from
greater realization of precision medicine's promise, we
worry that an unstinting focus on precision medicine by
trusted spokespeople for health is a mistake -- and a
distraction from the goal of producing a healthier
population," they write.
Arguing that
clinical intervention will not remedy pressing health
problems that arise from environmental conditions and
inequities in income and resources, they cite a 2013
report by the National Research Council and the Institute
of Medicine that found Americans fared worse in terms of
heart disease, birth outcomes, life expectancy and other
indicators than their counterparts in other high-income
countries. The report concluded that "decades of research
have documented that health is determined by far more than
health care."
They call for greater public investments in "broad,
cross-sectional efforts" to minimize the socioeconomic and
racial disparities in the U.S. that contribute to poor
health.
Bayer and
Galea say the NIH's most recent Estimates of Funding for
Various Research, Condition and Disease Categories
report shows that total support for research areas
including the words 'gene,' 'genome' or 'genetic' was
about 50 percent higher than funding for areas
including the word 'prevention.'
And investment in public health infrastructure,
including local health departments, lags substantially
behind that of other high-income countries.
"We need a
careful recalibration of our public health priorities to
ensure that personalized medicine is not seen as the
panacea for population health," Galea said. "We would
love to see the same enthusiasm directed to research
initiatives that would affect the health of millions of
people, such as treatments of chronic diseases, and
policy changes to address poverty, substance use and
access to education."
Bayer said, "We face increasing challenges to improve
health at the population level which entail addressing
certain persistent social realities and have little to do
with the frontiers of science. We must not let the current
focus on individualized medicine sidetrack us in advancing
a broad agenda that reduces health inequities both
domestically and across the globe."
Columbia University
Mailman School of Public Health. New England Journal
of Medicine
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