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NEJM Perspective: Focus on Precision Medicine Distracting From Efforts Seeking Healthier Population

NEW YORK (GenomeWeb) – The growing emphasis on precision medicine may not solve some of the more persistent problems plaguing population health, two public health experts wrote in the New England Journal of Medicine this week.

Columbia University's Ronald Bayer and Sandro Galea from Boston University argued in an opinion piece that the increased prominence of and funding for precision medicine initiatives won't address the social inequities that underlie the population health issues the United States faces.

In his State of the Union address this year, President Obama announced a $215 million Precision Medicine Initiative with the aim of developing more targeted treatments. National Institutes of Health Director Francis Collins and National Cancer Institute Director Harold Varmus then hailed the project in NEJM in February, calling it "visionary."

"The enthusiasm for this initiative derives from the assumption that precision medicine will contribute to clinical practice and thereby advance the health of the public," Bayer and Galea wrote in their own NEJM Perspective this week. "We suggest, however, that this enthusiasm is premature."

Instead, to improve public health, they said broad-scale efforts that address the socioeconomic and racial disparities in the US that lead to poor health are needed.

The overall US population fares worse on a number of health measures — such as adverse birth outcomes, obesity, and heart disease — than their counterparts in other high-income countries, the researchers said, citing a 2013 National Research Council and Institute of Medicine report. That report also noted that the discrepancy is more pronounced among socioeconomically disadvantaged groups.

Other studies the pair drew upon bolstered that view, and further noted that even when, such as in the UK, the cost of healthcare services isn't a barrier to receiving treatment, there remains social inequity in health. This and other findings, they said, suggest that the health differences between and within groups is influenced not just by clinical care, but also by social structure.

But the US, they added, invests little, as compared to other wealthy nations, on efforts to minimize poverty and racial residential segregation that drive poor health.

"Unfortunately, all the evidence suggests that we, as a country, are far from recognizing that our collective health is shaped by factors well beyond clinical care or our genes," Bayer and Galea said.

The pair noted, though, that precision medicine could contribute to improved clinical care, cautioning that it would only be for "a narrow set of conditions that are primarily genetically determined."

But there is enthusiasm for precision medicine that is lacking for population health. The researchers noted that NIH's recent Estimates of Funding for Various Research, Condition, and Disease Categories report showed that genomics-related projects received 50 percent more in funding than ones related to disease prevention. They similarly noted that CDC's budget is dwarfed by that of the NIH.

"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," Bayer and Galea said.