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Will Precision Medicine Improve Population Health

This article discusses the pros and cons of the precision medicine initiative in the improvement of population health. It has been stated that precision medicine may not improve population health primarily due to 3 reasons. The first reason is the unusual complexity of pathogenesis of diseases, particularly those that belong to the noncommunicable category. The association between many specific genes and conditions such as obesity, hypertension, and some cancers is illustrative of this Health, Inc. All rights reserved. 16 Obstetrical and Gynecological Survey opinion. Second, the fundamental premise of precision medicine is that it can help identify predictors of disease to guide interventions. This would be challenging to accomplish because although population studies can identify associations between genotypes and phenotypes, the consequent associations would have limited ability to predict phenotype in individuals, and it would take significantly stronger associations to provide adequate evidence to improve prediction of diseases in individuals. Third, an assumption about the precision medicine initiative is that disease in a population can be prevented when risk has been predicted in an accurate manner, because individuals would take precautionary measures by resorting to behavioral changes. However, the present scientific evidence is found to be contradictory to this assumption. Furthermore, it is postulated that the precision medicine initiativemay be a distracting factor in the efforts of the US national health research agenda in addressing the root causes of ill health such as poverty, obesity, education, and infant mortality. Shifts in the focus of funding agencies and record of similar previous endeavors that did not live up to the expectations have thus dampened the enthusiasm for the precision medicine drive. However, considering the positive aspects of the precision medicine drive, the following points have been put forth. Planning for the health of the population necessitates the correct channeling of and efficient utilization of resources for groups who are at risk. To this end, classification of populations into risk groups for several chronic diseases can provide effective prevention and treatment policies at lower costs. A case in point is the classification of women into risk categories for breast cancer screening based on age and polygenic risk score. Research evidence reveals that a genetically targeted approach to population health by means of newborn screening programs and genomic interventions for conditions such as hereditary breast and ovarian cancer syndrome, Lynch syndrome, and familial hypercholesterolemia has discernible benefits. A vital application of precision public health is the use of genomics in the examination and control of infectious diseases, which in turn has implications in other economic sectors including the environment, agriculture, animal health, and biotechnology. Thus, the future of population health lies in the implementation of a combination of approaches ranging from population-wide interventions to specific interventions adapted to suit the needs of higher-risk groups.