Do not let precision medicine be kidnapped

Abstract

Obama’s precision medicine initiative made the medical community boil over after the initiative’s release. Precision medicine has been advocated by the majority of scientists and doctors. However, some experts have questioned this concept. This article does not oppose precision medicine. However, the incentive of vigorously promoting precision medicine at present is a concern.

Keywords

precision medicine / personalized medicine / genomics

President Obama announced the precision medicine initiative in his State of the Union Address at the beginning of the present year [1]. The concept of precision medicine made the medical community boil over half a year later. The enthusiasm and advocacy for precision medicine in China is not inferior to that in the United States. National Health and Family Planning Commission and Ministry of Science and Technology of the People’s Republic of China held a symposium on April 15 with more than 30 experts in the biomedical field [2]. They aimed to establish an implementation plan and a development strategy for precision medicine in China. The First Precision Medicine Forum was opened a week later at the Tsinghua University, which is one of China’s top universities [3]. Six members of the Chinese Academy of Engineering and several government officials attended this meeting. They strongly advocated precision medicine by consensus and attempted to promote its incorporation in China’s 13th five-year development plan.

1 Precision medicine or precise health

The core philosophy of precision medicine is not new. Precision medicine aims to take individual variability into account in the prevention and treatment strategies, which is similar to the concept of personalized medicine. However, Obama’s current think tank hopes to convey a broader concept with precise tailoring therapies for subcategories of diseases or subpopulations of patients through genomics [4]. Is this indeed the case? Will genotyping accurately predict the individual risk of developing a disease in the era of big data? Everyone knows that health is determined by both internal (i.e., gene) and external (i.e., environment) factors. People with the same genetic background in different environments have varied phenotypic performance. The presence of a particular genetic polymorphism or haploid pattern does not play an ideal role in the development of the disease risk or drug response. Moreover, many confounding covariates (i.e., gene-environment interactions) are found in the correlation analysis. Furthermore, even two people with the same subtype of cancer have different genetic mutations [5,6].

China has made remarkable contributions to health promotion along with rapid economic growth in the last 50 to 60 years. Lifespan has increased from 40 years in 1950 to 76 years in 2011 [7]. China has been successful in prevention strategies and public’s participation in health care but has not been successful in embracing the gene-centric worldview. However, the current health burden for the Chinese has shifted to non-communicable diseases driven by urbanization, rising incomes, and aging. The urgent priority is to control the risk factors that are related to population exposure (i.e., air pollution, food and water safety, tobacco smoking, and obesity) instead of searching for genes [8].

2 Concerns on advocacy of precision medicine

Two concerns are found about the incentive of vigorously promoting precision medicine at present. First, a few scientific gurus who request research funding for genetics and molecular biology from the State may be driving precision medicine. Second, some genomics companies may take this opportunity to earn income for unnecessary gene sequencing. It reminds us of another fashionable concept: translational medicine. China has invested a significant amount of funds into research for translational medicine in the last decade. Is every stakeholder satisfied with the outcomes? Every scientist hopes that his or her experimental results are used in clinical practice. Every doctor likewise wishes his or her patients to be cured through individual treatment regimens. In any event, do not let precision medicine be kidnapped.

Compliance with ethics guidelines

Zhiping Yang declares that there are no conflicts of interest. The manuscript is a letter that does not involve a research protocol that requires approval from a relevant institutional review board or ethics committee. The views expressed are those of the author and are not necessarily those of his associated institutions.

References

[1] Collins FS, Varmus H. A new initiative on precision medicine. N Engl J Med 2015; 372(9): 793–795

[2] Anon. The National Health and Family Planning Commission and Ministry of Science and Technology of the People’s Republic of China hold a symposium on precision medicine (in Chinese). Central Government Homepage, 2015-April-29.

[3] Anon. Tsinghua University holds the First Precision Medicine Forum (in Chinese). Tsinghua News, 2015-April-23. (accessed 2015-May-18).

[4] Ashley EA. The precision medicine initiative: a new national effort. JAMA 2015; 313(21): 2119–2120

[5] Coote JH, Joyner MJ. Is precision medicine the route to a healthy world? Lancet 2015; 385(9978): 1617

[6] Joyner MJ, Paneth N. Seven questions for personalized medicine. JAMA 2015; 314(10): 999–1000

[7] Huang C, Yu H, Koplan JP. Can China diminish its burden of non-communicable diseases and injuries by promoting health in its policies, practices, and incentives? Lancet 2014; 384(9945): 783–792

[8] Yang G, Wang Y, Zeng Y, Gao GF, Liang X, Zhou M, Wan X, Yu S, Jiang Y, Naghavi M, Vos T, Wang H, Lopez AD, Murray CJ. Rapid health transition in China, 1990−2010: findings from the Global Burden of Disease Study 2010. Lancet 2013; 381(9882): 1987–2015

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Higher Education Press and Springer-Verlag Berlin Heidelberg