Why is personalized medicine relevant to public health?

Abstract

dvances in genomics promise a new era of personalized medicine in health care. A major promise of the 'omics' research is that of delivering new information that can transform health care through earlier diagnosis, more effective prevention programs and a higher precision in the treatment of disease. Almost 10 years after the definition of the term public health genomics (PHG) as 'the responsible and effective translation of genome-based knowledge and technologies into public policy and health services for the benefit of population health', we are still facing the dilemma of how to implement genomics medicine into public health practice. 1 Five main reasons can explain why progress was so slow. Firstly, from a philosophical point of view, the incorporation of the recent genome discoveries into public health practice deals with an apparent paradox. Although the mission of public health is to improve health from a population perspective, with its unit of inter- vention being the population, the individual approach of personalized medicine appears to be at odds. Secondly, over a decade after the sequencing of the human genome, few applications showed that the introduction of some genetic tests at the population level led to improved health, except for the newborn screening programs. Thirdly, in times of diminishing resources, new technologies have the potential to divert much needed resources away from what can be done in delivering basic public health services, with well-established evidence of effectiveness and cost-ef- fectiveness. Fourthly, most of the public health practitioners do not have the knowledge to integrate rapidly emerging genomic informa- tion into their programs. 2 Finally, behavioural interventions based on the knowledge of inherited risk have mostly failed to demonstrate their effectiveness to a large extent.