The increasing national focus on personalized or ‘precision’ medicine is misguided, distracting from broader investments to reduce health inequities and address the social factors that affect population health, two leading public health scholars argue in the New England Journal of Medicine.
The article written by prominent professors in the field of public health sheds light on why, in spite of outspending all other countries on health, the U.S. has poorer health indicators than many countries.
According to Sandro Galea, dean of the Boston University School of Public Health, and Ronald Bayer, professor of Socio-medical Sciences and co-director of the Center for the History and Ethics of Public Health at Columbia University, the fact that the United States continues to spend its health dollars overwhelmingly on clinical care, could be the reason why we are lagging behind other countries. Because health differences between groups and within groups are not driven by clinical care, but by social-structural factors that shape lives, said the scholars.
Bayer and Galea said that while investments in precision medicine may ultimately “open new vistas of science” and make contributions to a narrow set of conditions that are primarily genetically determined, they will not do much for public health as a whole.
They fear that the concentrated focus on precision medicine/personalized medicine is a mistake, as it distracts from the bigger goal of producing a healthier population. To reduce the socio-economic and racial disparities in the U.S. that contribute to poor health, the two noted public health gurus call for greater public investments in broad, cross-sectional efforts.
To add impetus to their theory that clinical intervention will not provide the solution to pressing health problems that arise from environmental conditions and socio-economic inequities, the authors draw attention to a recent report by the National Research Council and the Institute of Medicine. The 2013 report found Americans fared worse in terms of heart disease, birth outcomes, life expectancy and other indicators than their counterparts in other high-income countries. The report concluded that “decades of research have documented that health is determined by far more than health care.”
Bayer and Galea point out that in NIH’s most recent estimates, research funding for projects including the words ‘gene,’ ‘genome’ or ‘genetic’ was about 50 percent higher than funding for projects including the word ‘prevention.’ They also point out that investment in public health infrastructure in the U.S. lags substantially behind that of other high-income countries.
The authors are concerned that specialized medicine will push larger public health initiatives aside.
Galea cautions, “We need a careful recalibration of our public health priorities to ensure that personalized medicine is not seen as the panacea for population health.”
Bayer adds the health community is facing more and more challenges to improve at the population level. The focus, he said, needs to be on social realities, not pushing the boundaries of science.
They said they hope their article will help bring about policy changes to address poverty, substance use and access to education. They also hope to redirect some of the ‘personalized medicine enthusiasm’ toward research initiatives that would affect the health of millions of people.
Their goal is simple: Shift the current focus from individualized medicine to a broad agenda that reduces health inequities both domestically and across the globe.