The concept of precision medicine has emerged over the past decade and refers to developing prevention and treatment strategies that take individual variability into account. The aim is to provide the right treatment or prevention strategy to the right person at the right time. Doing this, we assume, will make for a better consumer experience and outcome (less wasted time and activity and more likely positive health outcomes) and a more efficient health system.
Much of precision medicine has focussed on treatment. Its origins have been well described by Chowkwanyun et al. (2018), including this quote by NIH Director Francis Collins, who defined it as “prevention and treatment strategies that take individual variability into account,” at the launch of President Barak Obama’s Precision Medicine Initiative in 2016. Precision medicine has demonstrated substantial benefits in cancer treatment, with the most appropriate treatment being targeted to a given individual.
Potential consumer benefits of precision public health include supporting a more informed consumer, through increases in direct to consumer testing.
The term precision public health was coined after this (well described by Khoury and colleagues in 2018) focussing on how to ensure that the advances in genomic science would be translated into population health benefits. Potential consumer benefits of precision public health include supporting a more informed consumer, through increases in direct to consumer testing, and improved health outcomes and reductions in inequalities in health, as health education and promotion strategies become more tailored to an individual’s genetic make-up.
One example of this genetically tailored prevention is the development of new heart disease risk prediction scores, taking into account genetics as well as the traditional risk factors such as smoking and high blood pressure. While we know that they are better able to sort people according to their future risk of heart disease, we don’t yet know whether their use will improve consumer experience and outcomes.
However, we know that genetics is only one of many powerful factors affecting our health and wellbeing. An increasing focus on the role of genetics could risk a lack of focus on our social, political, financial and environmental determinants of health. But the growth of big data analytics also opens windows to integrate information on an individual’s genetics, health status, and social and physical environment to develop prevention strategies more finely tailored to the combination experienced by a given individual or community. Marketeers are already using this combined information to sell us our heart’s desires. The hope of precision public health is to do the same for the best consumer experience and outcomes in health.
To truly benefit consumers we need to make sure the areas of research and application of precision public health are increasingly consumer driven rather than data and technique driven. More attention will need to be paid to how precision analytics can be applied to determine the optimal combination of population level and individual level interventions, and to identify more contextually tailored population level interventions, so that we don’t lose the scale and equity benefits of population wide actions to the lure of precision prevention applied only to the individual and their genetics.
Finally, while the growth in direct to consumer genetic tests and individually tailored digital health apps has potential benefits through increasingly informed consumers and increased access to health information and solutions, we are still to build the safeguards to protect consumers against the harms of overtreatment and inappropriate intervention that can accompany them.
Chowkwanyun, M., Bayer, R., Galea, S. N Engl J Med 2018; 379:1398-1400. “Precision” Public Health — Between Novelty and Hype.
Khoury MJ, Bowen MS, Clyne M, Dotson WD, Gwinn ML, Green RF, Kolor K, Rodriguez JL, Wulf A, Yu W. Genetics in Medicine 2018; 20: 574–582. From public health genomics to precision public health: a 20-year journey
Knowles JW, Ashley EA. PLoS Med 2018; 15(3): e1002546. Cardiovascular disease: The rise of the genetic risk score.
Newton J, Ekpe M, Bradley P. Public Health England Blog. Predictive prevention and the drive for precision public health. Posted on: 20 November 2018.