Precisely Where Are We Going? Charting the New Terrain of Precision Prevention

Abstract

In addition to genetic data, precision medicine research gathers information about three factors that modulate gene expression: lifestyles ,environments, andcommunities.Therelevantresearchtools—epidemiology,environmental assessment, and socioeconomic analysis—are those of public health sciences rather than molecular biology. Because these methods are designed to support inferences and intervention sad dressing population health ,the aspirations of this research are expanding from individualized treatment toward precision prevention in public health .The purpose of this review is to explore the emerging goals and challenges of such a shift to help ensure that the genomics community and public policy makers understand the ethical issues at stake in embracing and pursuing precision prevention .Two emerging goals bear special attention in this regard: (a) public health risk reduction strategies, such as screening, and (b) the application of genomic variation studies to understand and reduce health disparities among population groups.

Can Precision Medicine Reduce the Burden of Diabetes?

“…For example, the Precision Medicine Initiative Working Group Report envisions "empowering participants with data to improve their own health…this information may promote healthier behavior…." 18 Discussions of risk information in precision medicine often emphasize genetics, 16,19 in line with a discourse that has characterized the human genome as an individual's "instruction book," allowing people to "focus on the things we need to pay most attention to and less on the things for which we are not so much at risk." 20 Risk information may also derive from mobile devices or other measures that assess environmental and lifestyle factors (Table 1), or include psycho-logical and socioeconomic factors.…”

Precision Strategies as a Timely and Unifying Framework for Ongoing Prevention Science Advances

“…Multiple factors have been described as characterizing precision medicines which are common to precision prevention (Meagher et al 2017). Examples include the need for novel clinical trial designs; more reliable preclinical testing; developing networks of databases and research resources to support scientists, practitioners, and patients to accelerate the translation of basic science to practice; improving assessment of disease risk; understanding disease mechanisms; treatment matching; and finally understanding how applied uses of knowledge can be of most benefit to the recipients of intervention (Collins and Varmus 2015).…”

Genomic Essentialism: Its Provenance and Trajectory as an Anticipatory Ethical Concern

“…As Kuhn might have predicted, they argue that it will work better because its improvements are based on dramatically different epistemic and ontological assumptions that make comparisons with what has gone before difficult to make. A “new nosology” was thus necessary to organize the health sciences’ domain, which in the genomic context required “reformation” of biomedical training around genomic themes, proliferation of new clinical entities, reconceptualization of human populations, and reorientation of health care’s goals and metrics of success from treatment to prevention . In other words, the promoters’ appropriation of the notion of a paradigm shift was more than stylistic semantics: it reflected what they saw and praised as a scientific worldview that required different ways of thinking at multiple levels.…”

“…A "new nosology" was thus necessary to organize the health sciences' domain, 55 which in the genomic context required "reformation" of biomedical training around genomic themes, 56 proliferation of new clinical entities, 57 reconceptualization of human populations, 58 and reorientation of health care's goals and metrics of success from treatment to prevention. 59 In other words, the promoters' appropriation of the notion of The belief that natural causes make us who we are reinforces the demarcation of boundaries among groups and makes it easier to allow for genomic-based social segregation.…”