Public Health vs. Precision Medicine: Is It Really an Either/Or Proposition?

The "one-size-fits-all vs. tailor-made" argument is a false choice, as evidenced by recent initiatives undertaken to battle COVID-19. Hospital and health system leaders are best advised to not pick sides. Those who blend both types of approaches will fare best.

One size fits all versus tailor-made.

Those are the choices people make when they argue whether public health initiatives are just as or more valuable than precision medicine approaches in healthcare outcomes. As The Wall Street Journal recently noted in an article, "the COVID-19 pandemic has now highlighted a rival perspective in the debate."  

Those critical of precision medicine in the past are certainly having their day in the sun as public health initiatives take precedence in an effort to stamp out the new coronavirus. However, proponents of precision medicine are asking if it really is an either/or proposition.

We don't think so. Consider the ebriefings we have posted in recent weeks highlighting 1) how precision health and genomics might help hospitals respond to future COVID-19 outbreaks; 2) whether or not precision medicine can help alleviate COVID-19 testing backlogs; and 3) how precision medicine can help patients with cancer during the pandemic.

Moreover, precision medicine is also playing a role in predicting which COVID-19 patients might develop sepsis, a condition that some say should be addressed as a public health issue with population- and systems-based solutions. 

Toward predicting sepsis in COVID-19 patients, researchers, publishing in the preprint publication, medRxiv, analyzed the UK Biobank sepsis cohort to identify sepsis associated signatures and genes, and then compared these with individuals with COVID-19. They identified 70 sepsis risk genes ("many of them for the first time"); 60% were also present in severely ill patients with coronavirus.

"We have further identified 59 drug repurposing candidates for 13 of these targets that can be used for the development of novel therapeutic strategies to increase the survival rate of patients who develop sepsis and potentially severe COVID-19," the investigators wrote.

As more precision medicine approaches are coming into practice, in some cases perhaps kickstarted by the COVID-19 pandemic, hospital and health system leaders are best advised to not pick sides in the one-size-fits-all versus tailor-made debate. Rather, those who blend both types of approaches will fare best.

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National Institutes of Health (NIH) Director Francis Collins, MD, PhD (above), was recently quoted in the Wall Street Journal about picking sides when it comes to tailor-made precision medicine initiatives versus large-scale, one-size-fits-all public health initiatives. (Photo source: NIH.)

Value of Tracking Genetic Variants in Populations

Francis Collins, MD, PhD, Director of the National Institutes of Health (NIH), said in the WSJ article that some are setting up "a false dichotomy that you have to have either precision medicine or population health." But, he added, "It is not a conflict." When you know more about individuals, it helps you better understand populations. A genetic variant determines how difficult or easy it is for a virus to proliferate in an individual.

Additionally, picture a scenario in which a vaccine is developed but limited supply is available. Knowing which individuals are most vulnerable could help with determining who gets vaccinated first.

Possible to Develop Precision Medicine Pricing Models?

The problem, noted a group of 40 experts who were tasked with identifying barriers to precision medicine approaches by the World Economic Forum, is not science and technology. Rather, fixing policy and governance challenges is key. Specifically, if precision medicine is to experience a resurgence post-pandemic, "unlocking data, prioritizing inclusivity, and thinking pricing models are key to maximizing [its] full potential," states the report. The authors urged health systems and policymakers to quickly adapt to accelerate the move toward precision medicine in a post-COVID world.

"We must be ever vigilant about increasing the capabilities of many countries and populations to join this global movement towards more personalized and targeted ways of screening, preventing, diagnosing, treating and curing patients with disease." (We will report on the full the report, entitled, Precision Medicine Vision Statement A Product of the World Economic Forum Global Precision Medicine Council, in an upcoming ebriefing.)

Meanwhile, the debate rages on. Proponents of public and population health initiatives say that, if not for the pandemic, simple strategies such as hand-washing, better hygiene, quarantines, social distancing, and contact tracing, would be taking a back seat to "sexier" precision medicine initiatives. "There's a legitimate concern that old-fashioned, low-tech public health measures get undersold in the context of precision medicine," said Nathaniel Comfort, PhD, a professor at the Institute of the History of Medicine at Johns Hopkins University, in the WSJ article. Referring to COVID-19, he added: "A perturbation as large as this one can shift the narrative."

Which brings us back to the question: Does it really have to be an all or nothing proposition? Not according to Comfort. "The precision medicine and one-size-fits-all approaches have always been framed as opposites, as antagonists. It doesn't have to be that way. The problem that stands before us now is how do we change that?"

-Dean Celia

Related Information:

Covid-19 Raises Questions About the Value of Personalized Medicine

How Precision Health and Genomics Might Help Hospitals Respond to Future COVID-19 Outbreaks

Can Precision Medicine Play a Role in Alleviating COVID-19 Testing Backlogs?

How Precision Medicine Can Help Patients with Cancer During the Coronavirus Pandemic

Francis Collins, MD, PhD

World Economic Forum

Why Precision Medicine Won't Transform Healthcare - But Governance Could

Precision Medicine Vision Statement: A Product of the World Economic Forum Global Precision Medicine Council

Nathaniel Comfort, PhD