In Dutch health policy, new visions of future healthcare paradigms have been articulated over the past decade, where a multi-disciplinary knowledge base is expected to feed into prevention and treatment, responding to socio-economic health pressures whilst configured around the individual patient's needs. However, in parallel, life sciences research has undergone changes since the completion of the Human Genome Project. Increased knowledge of the human genome is expected to enable the development of drugs tailored to individual genotype, and improve treatment of chronic disorders. With much attention and science funding focused on the expected, but largely uncertain, contributions of genomics to healthcare, one may ask if we are witnessing unintended consequences, i.e. the slow erosion of public health and prevention? This paper uses colorectal cancer (also called colon or rectal cancer) genomics to demonstrate how visions of 'personalized healthcare' have been created around genomics that are essentially uncertain, while ongoing genomics funding affects other life science areas aligned with prevention. We sketch out better approaches to expectations management based on scenario building and policy coordination.

This paper presents a critical discussion of the actMties involved in a university-based human development project, in order to suggest guidelines for the evaluation of project proposals submitted by academics. The Lehurutshe Rural Development Project is based at Potchefstroom University (PU) and the University of North West (UNW), North West Province. The aim of the project is to establish the causes of and to find sustainable solutions for the environmentol and socio-economic problems experienced by five communities situated in the Lehurutshe and Marico magisterial districts, the former once being part of the homeland of Bophuthatswana. The author, who was the project methodologist for a period of about 30 months, focuses on two aspects that characterize every project. "imagery" and "practice". Concerning imagery. the author applies this concept to the applicants' conceptions of the objectives and methodologies of the project. With regard to practice, the author compares the results of a close reading of the project methodologies as contained in the project proposal, the results of meetings where methodologies to collect the datil were discussed, and the circumstances of two major surveys undertaken in the selected communities. Early on in the practice phase, scientific protocols of social interaction with the communities replaced a participatory methodology to which references could be found in the project proposal. The author argues that the subproject structure of the project more or less mi"ored existing scientific disciplines (micro-organizations), and that the representatives of these subprojects were at the same time embedded in activities normal within the maao-organizational environment of universities, such as teaching, examinations, and other research. The aoss-culwral Lehurutshe Project thus never gained an identity of its own, neither was there an acknowledgment of the gravity of the cultural issues involved. It remained a continuation of the research function within the range of normal academic activities. The author then makes suggestions for guidelines to be used in the evaluation process of project proposals.