Will Genomics Widen or Help Heal the Schism Between Medicine and Public Health?

Khoury, Muin J.; Gwinn, Marta; Burke, Wylie; Bowen, Scott; Zimmern, Ron

doi:10.1016/j.amepre.2007.05.010

Cited by 54 publications

(46 citation statements)

References 46 publications

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“…2,3 Defining and elucidating the multifaceted genetic interactions that underpin common complex diseases requires large-scale genetic studies with data from thousands of individuals. Biobanks, which are set up to store large collections of biological material for long periods of time, are the foundation for these studies.…”

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confidence: 99%

Consent to DNA collection in epidemiological studies: findings from the Whitehall II cohort and the English Longitudinal Study of Ageing

Meisel

Shankar

Kivimäki

et al. 2012

Genetics in Medicine

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Purpose: Epidemiological studies increasingly include DNA sampling in their protocols, but participation may vary by demographic, psychological, or health characteristics. This analysis explored sociodemographic (age, gender, religion, and education), health-related, and psychological predictors of participation in genetic data collection in two large epidemiological studies: the Whitehall II cohort and the English Longitudinal Study of Ageing. DNA consent in both studies was not obtained on initial enrollment, but after long-standing participation in the study. methods: Study participants who accepted or declined DNA sampling were compared.Results: Very few participants declined DNA sampling; 1.6% in Whitehall II and 1.0% in English Longitudinal Study of Ageing. In both cohorts, participants who declined were more likely to be female, nonwhite, and involved in religious activities; although only the ethnic effect consistently survived multivariate analyses. Decliners also felt less in control of events in their lives than those who consented, and this remained significant in multivariate analysis in the English Longitudinal Study of Ageing sample.conclusion: Consent to DNA sampling was very high in two established UK cohort studies. Differences between the subset of the population unwilling to provide DNA samples and those who consented were modest, although this may be due to the highly selected populations in these cohorts. However, our findings suggest that a greater proportion of decliners would create an important source of selection bias. 2012:14(2):201-206 Genet Med

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confidence: 99%

Consent to DNA collection in epidemiological studies: findings from the Whitehall II cohort and the English Longitudinal Study of Ageing

Meisel

Shankar

Kivimäki

et al. 2012

Genetics in Medicine

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“…Solid scientific evidence of nutrigenomics effectiveness and indicators of health determinants for global health need to be evaluated and justified. It has already been argued that a strong medicine and public health partnership in the genomics era is needed for the translation of most scientific discoveries into benefits for population health, including a commitment to evidence-based knowledge integration with several potential genomic applications in practice [95]. These efforts should be complemented with an emphasis on health services research to evaluate outcomes, over both the short and the long term, including attendant costs and benefits in the real world.…”

Section: Conclusion and Future Outlookmentioning

confidence: 99%

“…Although collective values are at the heart of public health activities, the interdisciplinary field of nutrigenomics is raising considerable questions for global health [16,95]. Solid scientific evidence of nutrigenomics effectiveness and indicators of health determinants for global health need to be evaluated and justified.…”

Section: Conclusion and Future Outlookmentioning

confidence: 99%

Nutrigenomics for Global Health: Ethical Challenges for Underserved Populations

Godard¹,

Hurlimann

2009

CPPM

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Nutrigenomics covers disparate fields of nutrition science and has been defined in many different ways. In fact, this emerging field of science has multiple facets, many of which do not generate the same ethical issues. In particular, different ethical issues emerge concerning the extent to which nutrigenomics may actually improve global health, i.e., in terms of worldwide improvement of health, reduction of disparities, and protection against global threats that disregard national borders. Nutrigenomics raises many hopes and expectations on that score. However it remains unclear and controversial whether nutrigenomics studies and their actual or potential applications will actually benefit developing countries and their populations. Different forces may drive the choice of research priorities and shape the claims that are made when communicating the goals or the results of nutrigenomics studies and applications. This article proposes to assess expectations and claims in nutrigenomics, with respect to their respective potential impact on global health and the ethical issues they raise. Nutrigenomics is and should be more than premature claims and much debated promises about personalized nutritional interventions on individuals. Beyond questionable commercial claims, nutrigenomics is also knowledge about and recognition of the considerable impacts of underfeeding and malnutrition on the genome (and epigenome) integrity and stability. As such, nutrigenomics research is a valuable opportunity to revive and give strength to the debate about the unacceptable consequences of hunger and malnutrition worldwide, and to support a newly and potentially significant convergence in research priorities that could benefit both developed and developing countries. 3 IntroductionNutrigenomics is a new application context for genomics technologies that focuses on the bidirectional study of genetic factors influencing host (individuals' or populations') responses to diet as well as effects of bioactive constituents in food on host genome and gene expression [1, 2]. This bidirectional approach to the study of genome-diet interaction creates a dual avenue for tangible nutrigenomics applications.Nutrigenomics is often described as one of the latest applications of genomics technologies in the field of personalized health interventions or personalized medicine, following the science of pharmacogenetics and pharmacogenomics. Yet, as it will be shown in this article, nutrigenomics goes beyond personalized health interventions. It covers disparate fields of nutrition science, which may pursue different goals and thus have multiple facets. Consequently, different ethical issues emerge, particularly in regard to the extent to which nutrigenomics may improve global health.There is no common understanding of the term "global health" [3]. Global health "is a field that encompasses […], processes, and institutions needed to create the conditions for people throughout the world to attain the highest possible level of physical and mental h...

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“…Some public health advocates contend that interventions based on environmental changes will be more effective than those focused on individual behavior change. By contrast, those supportive of a role for public health genomics argue that increasing knowledge of genomics and molecular pathology could unlock effective diagnostic techniques and treatments, as well as better target public health interventions [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Are public health professionals prepared for public health genomics? A cross-sectional survey in Italy

Marzuillo

Vito

D’Addario

et al. 2013

European Journal of Public Health

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Background: Public health genomics is an emerging multidisciplinary approach, which aims to integrate genome-based knowledge in a responsible and effective way into public health. Despite several surveys performed to evaluate knowledge, attitudes and professional behaviors of physicians towards predictive genetic testing, similar surveys have not been carried out for public health practitioners. This study is the first to assess knowledge, attitudes and training needs of public health professionals in the field of predictive genetic testing for chronic diseases. Methods: A self-administered questionnaire was used to carry out a cross-sectional survey of a random sample of Italian public health professionals. Results: A response rate of 67.4% (797 questionnaires) was achieved. Italian public health professionals have the necessary attitudinal background to contribute to the proper use of predictive genetic testing for chronic diseases, but they need additional training to increase their methodological knowledge. Knowledge significantly increases with exposure to predictive genetic testing during postgraduate training (odds ratio (OR) = 1.74, 95% confidence interval (CI) = 1.05-2.88), time dedicated to continuing medical education (OR = 1.53, 95% CI = 1.14-2.04) and level of English language knowledge (OR = 1.36, 95% CI = 1.07-1.72). Adequate knowledge is the strongest predictor of positive attitudes from a public health perspective (OR = 3.98, 95% CI = 2.44-6.50). Physicians show a lower level of knowledge and more public health attitudes than other public health professionals do. About 80% of public health professionals considered their knowledge inadequate and 86.0% believed that it should be improved through specific postgraduate training courses. Conclusions: Specific and targeted training initiatives are needed to develop a skilled public health workforce competent in identifying genomic technology that is ready for use in population health and in modeling public health genomic programs and primary care services that need to be developed, implemented and evaluated.

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Will Genomics Widen or Help Heal the Schism Between Medicine and Public Health?

Cited by 54 publications

References 46 publications

Consent to DNA collection in epidemiological studies: findings from the Whitehall II cohort and the English Longitudinal Study of Ageing

Consent to DNA collection in epidemiological studies: findings from the Whitehall II cohort and the English Longitudinal Study of Ageing

Nutrigenomics for Global Health: Ethical Challenges for Underserved Populations

Are public health professionals prepared for public health genomics? A cross-sectional survey in Italy

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