WASHINGTON – President Obama wants to support pioneering medical research. Hence his proposal to invest hundreds of millions of dollars in what is called now “precision medicine”. The idea is that by creating a detailed map of a person’s genetic make up it is possible to spot variants/abnormalities that become predictors of certain diseases.
The value of new knowledge
This new knowledge in theory will allow physicians to develop targeted preventative treatments and customized therapies. In principle this sounds like a very good idea. You gain detailed knowledge about potential physical vulnerabilities way ahead of time and so doctors intervene before the full-blown manifestation of disease.
Well, this sounds interesting. Except that in most cases it does not work this way. As Dr. Michael Joyner, anesthesiologist and physiologist at the Mayo Clinic, clearly explains in an instructive NYT op-ed piece, (“Moonshot” Medicine Will Let Us Down, January 29, 2015), most diseases do not originate from specific genetic variants. There are literally hundreds of variants that may lead to them. And therefore it is difficult to use an individual’s specific variant as a reliable predictor of anything.
Not so useful
As Dr. Joyner says, for most chronic and debilitating diseases, easy to ascertain life style factors are much stronger predictors of future health problems. For instance, if we look at the explosion of Type 2 Diabetes in the United States and other countries, the roots of the problem are in a bad diet and lack of exercise, as opposed to any individual genetic predisposition.
If people want to avoid Type 2 Diabetes, they should avoid a sugar rich diet and start a regime of moderate but regular exercise. Properly crafted and disseminated medical advice that would explain the value of these life style changes would be much more useful, at this stage, than any sophisticated individualized genome mapping.
The health value of embracing “Wellness”
This is not to say that pushing the envelope and pursuing new knowledge per se is a bad idea. This is to say that, if we really want to help an unhealthy US general population, finding good ways to spread “Wellness” education would give us much faster and far more substantial health gains.
As Dr. Joyner put it: “We would be better off directing more resources to understanding what it takes to solve messy problems about how humans behave as individuals and in groups. Ultimately, we almost certainly have more control over how much we exercise, eat, drink and smoke than we do over our genomes”.
All this looks terribly unsophisticated and unexciting. But a new focus on our unhealthy habits and how to change them shifts the burden of keeping our own health back to us.
No, we are not all impotent victims of our hidden genetic variants. Yes, there are cases in which individual genome mapping could indeed help doctors develop individualized therapies. But for the millions of Americans who are prisoners of debilitating (and costly) illnesses, such as cardiovascular diseases and Type 2 Diabetes, eating less sugar –this is something that we can control– will bring about much better health outcomes.