Precision Medicine, Genomics, and Public Health.

Abstract

Despite the advances in molecular genetics and… as genetic tests are proliferating in the U.S. population, their appropriate usage in the public health setting needs careful scrutiny.—Muin J. Khoury The issues that Muin J. Khoury (1) identified as relevant in the intersection of genomics and public health—rapid advances in the molecular technologies available for interrogating the genome, the proliferation of genetic and genomic testing in the clinical setting, uncertainties surrounding the use and value of such tests—are far from surprising. These issues form the basis of much discussion in today’s scientific, professional, and popular literature. What is perhaps surprising about the statement, however, is that it was made nearly 20 years ago. As advances in molecular genetics have marched steadily forward and genetic epidemiologists have attempted to generate useful public health knowledge, paradigms have meanwhile shifted and developing disciplines (e.g., epigenetics, metabolomics) now contribute substantively to the conversation. The challenges faced by public health practitioners in this context have stemmed from the shifting landscape upon which the discipline is built. President Barack Obama's Precision Medicine Initiative (PMI), unveiled during his 2015 State of the Union Address, represents a concerted effort to lay the scientific foundation for the careful scrutiny Khoury called for. How does this PMI impact the prevention and treatment of diabetes? As public health practitioners, we must face the current reality of the high and increasing global prevalence of diabetes. Between 1980 and 2008, the global age-standardized diabetes prevalence increased from 8.3 to 9.8% in men and from 7.5 to 9.2% in women (2). Precision medicine (PM) may offer new strategies to prevent and reduce diabetes in populations. PM seeks to integrate a bounty of data from each person's genome—combined with data from his or her environment and lifestyle (i.e., behaviors)—to tailor medical treatment to the individual …