Population Health in the Precision Medicine Era
A lot of excitement has accompanied the launch of President Obama’s Precision Medicine Initiative, with its promise to revolutionize disease management by leveraging advances in health information technology. The initiative has also elicited some concern over its potentially negative impact on efforts to improve population health. A viewpoint article published in JAMA delineates how a focus on precision medicine could either hinder or bolster public health.
As the authors describe, using genomic information to predict disease incidence and guide treatment decisions is a cornerstone of precision medicine. However, the genetic contribution to many conditions is generally small, making it difficult to predict whether a genetic change will manifest as disease. This poor predictability limits the translation of genetic discoveries into interventions that can improve health for large numbers of people. Moreover, even if precision medicine does lead to accurate prediction of disease risk for individuals, people may not act on the information, further limiting population health benefits.
Perhaps of more concern than these obstacles, though, is that as the spotlight turns on precision medicine attention will be shifted from the widespread social and economic causes of poor health. With precision medicine comes a focus on finding the characteristics that set patients apart – a major contrast to the public health approach, which devises a broad array of interventions targeted at large groups of people. The article indicates that funding for public health research has decreased over the past decade while funding for genomics and the other “ –omics”–type research largely used in precision medicine has increased.
Despite these caveats, the authors highlight ways in which population health can be improved by precision medicine. Specifically, by applying precision medicine methods to public health research, scientists can identify groups at high risk for certain diseases and create tailored, population-level health interventions. Ultimately, by combining the genomic and other biological data underpinning precision medicine efforts with the traditional public health approach, improvements in both individual and population health can be realized.