Personalized medicine: a bridge too far

The Weekly Packet.  September 28, 2016

I captured the hummingbird images accompanying this posting while sitting quietly on our deck at camp. They are fascinating creatures. (If you hover over the photos, you should be able to click and get full-screen images with camera data.)

I ‘m leaving in two days for a short fly-fishing trip to Lewis and Clark country with a local group; we’re fishing the Missouri outside Craig, Montana. It will be a chance to tune out the clamor of the election for a couple of days, and I look forward to it.

Meanwhile, I want to direct your attention to a couple of items that caught my eye recently. The first was a comment in a New York Times article that referenced a piece that appeared in Slate. The data are well-referenced, and even if off a few percentage points one way or another, they are frightening. No, not the latest election polls, but the fact that more than half the world’s population does not have access to flush toilets. In fact, yesterday the Science section of the Times reported that a half-million homes in the US don’t have adequate plumbing. Simple sanitation, with sewage treatment, access to clean water for washing and drinking, and preventive immunization are the foundations of public health.

The second issue is a World Health Organization report that appeared on Sept. 27th, and was the subject of a New York Times piece by Mike Ives. The data indicate that over 90% of the world’s population breathes air with unsafe levels of fine particulates. Perhaps just about now, many of you think I have gone off some sort of deep end. Give me just a second. My older son, David, is an environmental economist who has worked on the health costs of particulate pollution for a couple of decades. The health costs are real and well-documented.

Recently my former chief at the Cleveland Clinic, Eric Topol, published a book titled The Creative Destruction of Medicine. In it, Eric advocates for his view of highly personalized medicine with management informed by genomics and driven by constant data acquisition using smartphones or similar devices. My simple view is that genomics and personalized medicine is a bridge too far in the war on disease when millions of humans don’t have toilets, and few of us can avoid inhaling particulates with every breath. And when our ageing infrastructure holds the potential for many more Flints here at home.

The official White House website   https://www.whitehouse.gov/the-record/climate  states that President Obama believes, “no challenge poses a greater threat to our children, our planet, and future generations than climate change.” Whatever your political persuasion, I think we can all agree that the President is a bright man who has a remarkable context in which to decide what issues merit the most concern.

I think those of us in medicine and in the pharmaceutical industry have a responsibility to the public. We continue to see hospitals competing with ads for their cancer centers, heart centers, bariatric programs, and joint replacement surgeries. We continue to see drug companies advertising new agents with short spots that build unrealistic expectations of benefits and minimize risks. Let’s speak up to the public through our professional organizations, and push for a few years of redirecting these institutional advertising budgets toward real public health: clean air and clean water!

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