More About Prospective Health Care

Abstract

To the Editor: Dr. Campos-Outcalt’s response1 to our August article2 totally missed some key points. First, he stated that prospective health care is “defined as genomics-based medicine.” This could not be further from the truth or what we meant to convey. Although prospective medicine integrates genetic risk factors when appropriate and validated, it is defined as personalized, predictive, preventive, and participatory medicine that utilizes many tools and capabilities to foster strategic health planning. We clearly pointed out that the “know-how and capabilities to be proactive already existed” before the capabilities resulting from research in genomics emerged. Fields such as genomics, proteomics, metabolomics, systems biology, bioinformatics, and diagnostic imaging will enhance the move towards prospective medicine, but they do not define it. The key to prospective care is strategic health planning. Second, Dr. Campos-Outcalt stated that we attributed today’s health care system ailments to the absence of a “personalized” system rather than to the lack of universal coverage and overemphasis on specialty care. This is not the case; we clearly stated that today’s health care crisis is partially attributable to focusing on the treatment of disease events as well as being reactive and sporadic, leading to ineffective prevention of chronic conditions. Furthermore, we cited other significant contributing factors, including the current state of health care insurance and reimbursement systems. The prospective health care approach is one means to address the problems plaguing our system. Our article indicates our belief that, in addition to prospective health care, changes in access to health care insurance, the reimbursement system, and public health measures will all be needed to create a rational health care system. Finally, the claim that we “appear to believe that medical intervention has the major role to play in preventing illness,” as opposed to community-based approaches, is erroneous. Although in our article, we focused on individualized health care, we clearly stated that “public health and personalized approaches should be synergistic and will compel the close engagement of public health and medicine.” In conclusion, we respectfully request that Dr. Campos-Outcalt reread what we wrote. Ralph Snyderman, MD Chancellor emeritus, Duke University, and James B. Duke Professor of Medicine, Duke University Medical Center, Durham, North Carolina; ([email protected]). Ziggy Yoediono, MD, MBA Senior research fellow, Duke Center for Research on Prospective Health Care, Duke University Medical Center, Durham, North Carolina.