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Moving Into the Future

Ron Zimmern, chairman of the Foundation for Genomics and Population Health, had some words of admonishment for public health officials the world over at the 4th National Conference on Genomics and Public Health in Maryland this week — it's time to move into the 21st century way of doing things, he said. Public health genomics means combining human genomics and the study of environmental determinants of public health, Zimmern said. In addition, there has been a dichotomy between the people who study the science and the public health officials, though that must change, he added. The two areas of study are actually quite complementary, as there can be no effective public health practice without a thorough understanding of biology. There has been an "exponential growth of data," Zimmern said, and it all has to be analyzed. So "public health must move from the 19th century" into the future, he added — from the study of environmental concerns like sewage and clean water and into bioinformatics. There are obstacles, however. There is still a lack of clarity among public health officials about what genomics can achieve and a lot of mythology about personalized medicine ("Medicine has been personalized since the time of Hippocrates," Zimmern said.), but these problems can be managed. Everything public health researchers do should be driven by clinical utility and not in using new technology, and they also need to manage expectations about the potential of genomics, distinguishing between hype and reality, he said. There is also a discrepancy between clinical practice, which is individualistic and autonomous, and public health practice, which is paternalistic and collective. Whereas the individual patient has the final word in their treatment in clinical practice, public health practice is all about telling people what to do and what's good for them, though that needs to change, Zimmern said. Officials need to be "empowering citizens through information to improve their health," not acting as "a draconian state, telling them what to do," Zimmern added.

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