"Precision medicine or population health? On the face of it, the two couldn’t be further apart: one aims to tailor treatments to the few while the other works to confront disease for millions on a global scale. A recent seminar at Columbia University’s Mailman School of Public Health brought together experts from both fields to locate common ground.
In 2014, Columbia President Lee Bollinger announced a university-wide precision medicine initiative. Nearly a year later, in his State of the Union address, President Obama launched a similar effort on the federal level, committing $214 million for research. Made possible by rapid advances around the human genome, both initiatives aim to broaden understanding around genetic variation in disease to better match patients with effective therapies.
The goals of population health are no less grand. Wafaa El-Sadr, who hosted the discussion, enumerated several principles, from ensuring maximum benefit for the largest number of people to intervening at multiple levels from behaviors to the environment to social conditions. Population health takes a global view, added El-Sadr, University Professor and director of ICAP and the Global Health Initiative, with special attention to disparities between haves and have-nots.
David Goldstein, director of Columbia’s Institute for Genomic Medicine, a centerpiece of the University’s Precision Medicine Initiative, said his field shares an interest in overcoming disparities. “When we reviewed them a few years ago, we found that large-scale genomic studies were being performed on individuals of European ancestry at a rate tenfold greater than all other ancestry groups put together,” Goldstein said. As a result, clinicians are significantly less able to rule out genetic factors that contribute to disease in underrepresented individuals.
Jessica Justman, associate professor of Medicine in Epidemiology and senior technical director at ICAP, proposed one avenue for collaboration involving the large-scale population surveys she currently leads in Sub-Saharan Africa that collect detailed HIV and other health information. African scientists are interested in genetic research, particularly into diseases like diabetes, tuberculosis, and sleeping sickness, added El-Sadr.
By one measure, population health and genetics have been with us for decades. “The largest public health program in genetics is newborn screening,” said Wendy Chung, a pediatrician and geneticist at Columbia University Medical Center. Since the early 1970s every child in the United States has been screened for genetic conditions, including metabolic disorders treatable with a modified diet. According to Chung, the next frontier is doing a similar genetic screening for adults, although she cautioned that much work is needed before such tests are ready for primetime."