Before becoming a genomics journalist six years ago, I spent five years covering the occupational health and safety industry. I reported for and about toxicologists, industrial hygienists, and safety managers whose job it is to protect workers from suffering on-the-job injuries, chemical exposures, high noise levels, and other hazards that would not just endanger employees, but likely lead to major expenses for employers. In the world of workplace health and safety management, everyone knows that the best way for an employer to keep productivity up and disability, workers’ comp, and litigation costs (not to mention OSHA fines) down is not to let job injuries happen in the first place. Aside from obvious steps like keeping equipment in good repair and providing protective equipment, the companies with the best safety and health records were those that implemented programs that empowered workers to take responsibility for their own health, and educated them about safe behaviors.
So it was that, after five years of reporting incessantly on preventive care and behavioral modification programs, I suffered culture shock coming to genomics. The goal of any research in this field, including the Human Genome Project, seemed to be about finding new drug targets. The big-pharma-driven economics of the field made it easy to understand why this was the case. But it seemed curious that the benefits of using genomic knowledge to help people avoid suffering disease in the first place were hardly discussed.
Over the years, it’s been the rare genomics researcher who’s taken to the podium to talk about preventive healthcare. Maynard Olson was one, in an irreverent talk at the 2002 Genome Tri-Conference, when he urged NIH to pay more attention to the third letter in its acronym, and appealed to researchers to study “individuals in the population whose mutations don’t make them sick but confer an advantage in modern life.”
Recently, however, preventive health studies seem to be gaining attention in genomics spheres.
At a discussion on the future of medicine hosted by Bristol-Myers Squibb in New York on October 16, Virginia Stallings, professor of pediatrics at the University of Pennsylvania School of Medicine, emphasized the importance of understanding genomics in combination with environment and nutrition. In a culture where “supersizing is epidemic,” Stallings noted, integrated knowledge, and even diagnostics at the fetal stage of development, should be used to encourage behaviors that could result in averting diseases over a lifetime. “If we do our job right, we’ll put most of these other folks out of jobs,” she said, getting laughs from her copanelists, including experts in cancer, neuroscience, and cardiovascular research, as well as the CSO of Bristol-Myers Squibb, James Palmer.
(Asked later what the success of preventive strategies could mean to big pharma, Palmer commented to me that, clearly, “altering behaviors is where personalized medicine is going” — but that it’s not as if pharmas will be left without diseases to treat. After all, averting one illness enables a person to live long enough to contract another.)
Preventive “personalized health planning” was also the buzz phrase at GSAC in Savannah this year, where Ralph Snyderman, president and CEO of the Duke University Health System, described what he and others envision as the new approach to primary care medicine (see p. 16). Snyderman told Genome Technology’s sister publication SNPTech Reporter in October, that “at some point, genomics, by providing susceptibility information, will be part of a healthcare system in which we try to intervene or prevent at the earliest possible time, rather than what we are doing now, which is treating after an event occurs.”
For instance, Snyderman said that Duke researchers are engaged in a project to develop early-stage risk-assessment tools for individuals at risk for obesity, and, as a consequence, diabetes, cardiovascular disease, and other associated illnesses. In Savannah, Snyderman scorned the “reactive, sporadic” way modern medicine is practiced and said that personalized health plans could empower individuals to assume greater responsibility for their own health.
A GSAC audience member wondered aloud what good all this information on prevention would do if patients don’t have the education or the self-discipline to put it to use. Perhaps employers who’ve used behavioral psychology and worker empowerment programs to get job injury and illness rates down have something to teach the rest of the healthcare community.
Adrienne J. Burke, Editor in Chief