Public health in an era of personalized medicine
Thursday, February 25, 2016
Collectively, the clinical medicine and public health communities have demonstrated to governments and their populations that public health programs and interventions are critical to reducing infectious and chronic diseases.
Furthermore, much of the success of public health interventions has been achieved with only a fraction of the public and private spending on clinical medical care. However, these investments by governments and private healthcare organizations are generally unrecognized by the public.
In recent years, Western governments and the healthcare communities have shifted much of their attention toward personalized or precision medicine. Precision medicine can be defined as a system of care focused on the prevention, early detection and targeted treatment of disease. This is based on individualized variability in genetics, lifestyle and environmental exposure.
While personalized medicine is not receiving worldwide utilization, public health leaders are concerned this focus on precision medicine may reduce funding for evidence-based public policy and systems relevant to health surveillance. Many of these monitoring systems are critical to many global public health issues such as HIV/AIDS, Ebola, antibiotic resistance, cardiovascular disease and emergency management of disasters.
Is it possible that precision medicine could lead to stovepiping of healthcare?
While there is significant debate about excessive healthcare costs and utilization among policymakers, public health professionals, private healthcare professionals and the general populace, the likely course of action in this era of precision medicine is one that continues to integrate the disciplines of clinical medicine and public health.
Historically, the art of clinical medicine combined with the science of public health has worked together to prevent disease and promote health down to the individual patient. However, advances in machine learning and big data analytics could transform the clinical management of the patient. Today, estimates of disease risks and projections of health outcomes are largely based on population averages.
Globally, improvements in clinical medicine have transformed life expectancy and the level of healthcare for any given patient and greatly reduced healthcare inequality among various groups. The philosophy of personalized medicine inadvertently separates patients into distinct groups and attempts to use a "Google analytics" approach to guide clinical interventions and predict physiological responses, disease subtype, clinical outcomes and individualized disease risks.
Public health priorities must be combined with the priorities of personalized medicine to ensure population health objectives are on target. Furthermore, research initiatives must continue to investigate healthcare inequality, access to care and the numerous socioeconomic factors that contribute to disparities in disease and disability.
I urge the readers of this article to gain a better understanding of public health and precision medicine. Be sure to share below the answer to this question, "What does precision and personalized medicine mean to me?"
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