Precision medicine’s got its legion of believers, but there’s a healthy dose of skepticism in the medical community – as outlined in a balanced new JAMA piece, “Precision Medicine: The Future or Simply Politics?”
Obama thrust the topic in the spotlight in January when he announced his Precision Medicine Initiative – committing some $215 million to explore the genomic patterns and links among the American populace. A valuable effort, sure, but here are the counterarguments presented in the JAMA piece:
Why is something as costly and involved as precision medicine crowding the spotlight? What about the other public health initiatives? Nigel Paneth, a biostatistics and epidemiology professor at Michigan State University, says he often tells people that diet and exercise can cut the risk of converting from prediabetic to diabetic by two-thirds.
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“Do we hear about this?” he told JAMA. “Of course not. It’s not sexy.”
Precision medicine may work well for the patient with a rare cancer that isn’t responding to a prescribed treatment regimen – but does it have any implications for improving population health? That’s less likely – so what’s the ROI? Why are federal dollars going into something that may not have the biggest bang for its buck?
Additionally, as Jeffrey Matthews, chair of surgery at University of Chicago, tweeted on February 4: There’s a chance precision medicine “will fall short of its catchy name.”
“The idea of packaging it as a new paradigm, precision medicine, (suggests) that somehow everything else is not precise medicine,” Matthews told JAMA. “It sounds great. But it is being oversold and overhyped, and it’s creating unrealistic expectations on the part of patients and clinicians.”
A Jan. 29 opinion piece in the New York Times from Mayo Clinic doc Michael Joyner calls the initiative a “moonshot” medical research initiative.
“We would be better off directing more resources to understanding what it takes to solve messy problems about how humans behave…,” Joyner wrote. “Ultimately, we almost certainly have more control over how much we exercise, eat, drink, and smoke than we do over our genomes.”
That opinion’s likely to stick among precision medicine proponents. It’ll be interesting to see what kind of timeline it’ll take to bring some real, actionable change in healthcare via precision medicine.
