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All the Pieces

Genes are but one piece of the medical puzzle, says Abigail Zuger at the New York Times' Well blog.

Zuger writes of a patient of hers called Barbara whose medical record, spanning 20 years, she says could be published as a cautionary tale entitled "Genes, Lifestyle, and Environment."

"Which chapter came first?" Zuger asks. "Was it the genetic predilection for alcohol that created her lifestyle (pure chaos) and environment (streets, shelters, hotels)? Or did the story start at another point in the cycle, with alcohol selected as a comforting longtime companion, then taking over?"

In the end, Barbara has a bad heart, liver, and lungs as well as bad hips and AIDS.

While Barbara likely has some genetic predisposition toward alcoholism, Zuger wonders how precision medicine efforts like the one announced by President Barack Obama would help patients like Barbara. Zuger says that both an analysis by a powerful database and by Barbara herself would come to the same conclusion: "'Gotta find a place to live, gotta make new friends, gotta take my meds.'"

While Zuger notes that Barbara may be an extreme example, she adds that she thinks "most chronic disease puzzles will turn out more like hers than the fix-a-gene, save-a-life sequence the precisionists envision."