Rapid advances in personalized medicine have sparked interest in another new idea: precision public health.
Essentially, it’s the thought that if doctors could pinpoint populations with genetic vulnerabilities — like those prone to obesity, depression, or cancer — they might be able to treat those diseases sooner, slow their progression, or even prevent them altogether. It could be a more effective preventive medicine tactic than the blanket approaches used right now.
“We are treating to the mean effect,” Donna Arnett, a researcher and the dean of the University of Kentucky College of Public Health, said in a talk Tuesday hosted by the Boston University School of Public Health. “We have to think just beyond the mean.”
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This critiques a straw man. Perhaps if we started with less costly, periodic screenings for heavy metals, food sensitivity, Lyme and coinfections, mold toxicity, biocompatibility vs. reactivity to dental materials, and low-grade dental and jaw infections not yet visible on xray, we could have the majority of the benefits at less cost.
In other words, while genetic testing of SNP variants gives information on susceptibility to various pathogens and elements that challenge our cells, microbiomes, and health – many of the above personal and public health threats are not good for anyone. Home inspections check for radon, but not mold. Physicians rule out Lyme, but often do not test for coinfections. Standard heavy metals tests are paradoxically low for people with high bound up mercury levels, because when bound tightly to electrons it does not circulate, but concentrates in the jaw, GI tract, kidneys, and liver. Dental and jaw infections often take down pets, horses, livestock, etc., and we are just another aging and inviting host to similar pathogens.
U.S. Medicine is unbalanced and imprecise in what it measures. It ignores a huge wall between medical and dental care, and mundane threats from the environment. There is no guideline or requirement for biocompatibility screening before putting metals, plastics, etc. in the mouth or body, where one has 24/7/365 exposures for a lifetime. See my StatNews column of last December, Congress needs to turn its attention to medical device safety. (https://www.statnews.com/2016/12/21/medical-devices-safety-congress/)
The cost of whole genome sequencing is rapidly falling. AI will bring down interpretation costs. There are cheaper pathways to nondiagnostic, first pass/first look type screening. It is certainly less costly than lifetime medication delivery and management for chronic autoimmune, cardiovascular, metabolic, and/or neurological diseases that are growing like mushrooms in the U.S. – especially given the recent spike in price hikes for generics.
The well-attended Powering Precision Health Summit organized by Summit Founder and Quanterix CEO Kevin Hrusovsky, and cosponsored by MassBio, in October did an excellent and balanced job of including both personal and public health factors in the conversation, in addition to genetics, and pushing the envelope on diagnostics. Exposures are a huge factor – from concussions to lead, asbestos, tobacco, and all the ubiquitous toxins we are hesitant to consider in the United States – until the coffin nail of single factor, RCT proof is nailed shut. The US needs much stronger nails and bigger hammers than much of the world, where independent journals and non-industry-sponsored research still persists.