Promise of genomics research needs a realistic view

Promise of genomics research needs a realistic view

This is James P. Evans, M.D., Ph.D., of the University of North Carolina at Chapel Hill.

From the February 17, 2011 Eureka news alert

In the ten years since the human genetic code was mapped, expectations among scientists, health care industry, policy makers, and the public have remained high concerning the promise of genomics research for improving health.

But a new commentary by four internationally prominent genetic medicine and bioethics experts cautions against the dangers of inflated expectations – an unsustainable genomic bubble – and it offers ways to avoid it while still realizing “the true – and considerable – promise of the genomic revolution.”

“This commentary is an attempt to bring some balance to the hopes and claims that swirl around the issue of genomic medicine. It is a cautionary essay that tries to extol the real and formidable potential of genomic medicine but also attempts to counter what we see as exaggerated claims, said lead author medical geneticist James P. Evans, MD, PhD, Bryson Distinguished Professor of Genetics and Medicine at the University of North Carolina at Chapel Hill and the UNC Lineberger Comprehensive Cancer Center.

“Our fear is that if we are uncritical and naïve in our enthusiasm for these exciting technologies we risk both diversion of precious resources and premature implementation which could hurt patients – as well as a backlash which will hurt our field,” Evans warns.

The commentary appears in the February 18, 2011 issue of the journal Science. Co-authors with Evans are Eric M. Meslin, PhD, director, Center for Bioethics, Indiana University, Indianapolis; Theresa M. Marteau, PhD, FMedSci, professor of health psychology, Kings College, London, UK; and Timothy Caulfield, LL.M., F.R.S.C., Canada Research Chair in Health Law & Policy, University of Alberta, Edmonton, Alberta.

“Breathtaking” is how the authors describe the progress already made in genomic research. But, they caution, the considerable promise of genomics must be evaluated through a realistic lens. Advances in individualized medicine, or pharmacogenetics for example, still require the importance of human behavior in health outcomes: the most powerful predictor of a drug’s efficacy depends less on genetics than whether the patient takes the drug.

Among the reasons they cite making genomics the persistent recipient of “hyperbole” and inflated expectations, some are tied to impatience for practical applications, market forces and unbridled (but uncritical) enthusiasm. The news media also is named for “playing an obvious role in the creation of unrealistic hopes.”

“These forces act together to produce a kind of “cycle of hype” that drive overly optimistic representations of the research,” said co-author Timothy Caulfield.

In their short-list of recommendations for avoiding inflation of the “genomic bubble, Evans and co-authors offer the following: (1) reevaluate funding priorities to stress behavioral and social science research aimed at behavior change for improving health; (2) foster a realistic understanding “of the incremental nature of science and the need for statistical rigor,” within the scientific community and that the media make more responsible claims for genomic research; (3) maintain a focus on developing high-quality evidence before integrating good ideas into medical practice.

“By highlighting the risks of continuing to promise results from genomic science, we were hoping to draw attention to a more sustainable approach to reaping the benefits from genomic science,” said co-author Eric Meslin.

The authors assert their belief that the current age of genomics will provide great benefits to human health “Ours is not a call to gut existing research or too-rigidly tie funding to degree of disease burden … The pursuit of our common goal – improved human health – demands that we take a hard look at disease causation and order our priorities accordingly.”

 

Related Web sites and articles

The Genomic Revolution (exhibit by the American Museum of Natural History) is an online Web site with videos

(US) Human Genome Project Information

The Genomic Revolution: Unveiling the Unity of Life [online book]

Genome Revolution FOCUS (a Duke University Library Guide)

Genomic Links (online resources for professionals, teachers, and all)

 

 

 

Homeless people without enough to eat are more likely to be hospitalized

Homeless people without enough to eat are more likely to be hospitalized
Mass. General study is first to document association between food, use of health services

From the February 3, 2011 Eureka news release

Homeless people who do not get enough to eat use hospitals and emergency rooms at very high rates, according to a new study. One in four respondents to a nationwide survey reported not getting enough to eat, a proportion six times higher than in the general population, and more than two thirds of those had recently gone without eating for a whole day. The report will appear in the Journal of General Internal Medicine and has been released online.***

“The study is the first to highlight the association between food insufficiency and health care use in a national sample of homeless adults,” says lead author Travis P. Baggett, MD, MPH, of the Massachusetts General Hospital (MGH) General Medicine Division. “Our results suggest a need to better understand and address the social determinants of health and health-care-seeking behavior,”

Baggett and a team of investigators at MGH and the Boston Health Care for the Homeless Program analyzed survey data from 966 adult respondents to the 2003 nationwide Health Care for the Homeless User Survey. They found that homeless people who did not have enough to eat had a higher risk of being hospitalized in a medical or psychiatric unit than did those with enough to eat and also were more likely to be frequent users of emergency rooms. Neither relationship could be explained by individual differences in illness. Nearly half of the hungry homeless had been hospitalized in the preceding year and close to one-third had used an emergency room four or more times in the same year.

Baggett explains the study was sparked by his clinical experience caring for homeless individuals. “Homeless patients with inadequate food may have difficulty managing their health conditions or taking their medications. They may postpone routine health care until the need is urgent and may even use emergency rooms as a source of food. Whether expanding food services for the very poor would ameliorate this problem is uncertain, but it begs further study.” Baggett is an instructor in Medicine at Harvard Medical School.

 

For suggestions on how to get a free or low cost copy of this article, click here.

 

 

Healthy People 2020 sets health promotion, disease prevention agenda for the nation

From the Healthy People about page

Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to:

• Encourage collaborations across sectors.
• Guide individuals toward making informed health decisions.
• Measure the impact of prevention activities.

Healthy People 2020 strives to:

• Identify nationwide health improvement priorities.
• Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress.
• Provide measurable objectives and goals that are applicable at the national, State, and local levels.
• Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge.
• Identify critical research, evaluation, and data collection needs.

The 40+  2020 topics and objectives include

• Adolescent health
• Diabetes
• Educational and Community-based Health
• Environmental Health
• Food Safety
• Heart Disease and Stroke
• Lesbian, Gay, Bisexual, and Transgender Health
• Medical Product Safety
• Occupational Safety and Health
• Public Health Infrastructure
• Social Determinants of Health
• Vision

Social Determinants of Health – The Canadian Facts

Social Determinants of Health: The Canadian Facts. by J Mikkonen & D Raphael Foreword by Hon. Monique Bégin (Former Minister of National Health & Welfare of Canada) Published in May 2010. ISBN 978-0-9683484-1-3 – 62 pp [63p.]http://thecanadianfacts.org/The_Canadian_Facts.pdf

“……The primary factors that shape the health of Canadians are not medical treatments or lifestyle choices but rather the living conditions they experience. These conditions have come to be known as the social determinants of health. This information – based on decades of research and hundreds of studies in Canada and elsewhere – is unfamiliar to most Canadians. Canadians are largely unaware that our health is shaped by how income and wealth is distributed, whether or not we are employed and if so, the working conditions we experience.”

Improving the health of Canadians requires we think about health and its determinants in a more sophisticated manner than has been the case to date. Social Determinants of Health: The Canadian Facts considers 14 social determinants of health:

1. Income and Income Distribution 2. Education 3. Unemployment and Job Security 4. Employment and Working Conditions 5. Early Childhood Development 6. Food Insecurity 7. Housing 8. Social Exclusion 9. Social Safety Network 10. Health Services 11. Aboriginal Status 12. Gender 13. Race 14. Disability

“The publication outlines why they are important; how Canada is doing in addressing them; and what can be done to improve their quality. The purpose of the document is to provide promote greater awareness of the social determinants of health and the development and implementation of public policies that improve their quality. ….”

From: Open Medicine Blog #261