Letters to the Editor
Dr. Snyderman, Dr. Yoediono, and I are in agreement that personalized medicine should consist of more than genomics, our health system is too disease-oriented, the current reimbursement system needs change to better compensate primary care and prevention, and public health interventions should be a major part of health care reform. We also agree that academic health centers should lead by conducting research into what really improves health and what does not.
The main point of my comments, however, remains that the personalized, predictive, preventive, and participatory approach they described may not achieve better outcomes or lower cost and could lead to the exact opposite. A fifth “p” is badly needed: proven. A quick visit to any of a number of personalized medicine Web sites will reveal how many of the services offered, genomic-based and others, are of unproven effectiveness. The evidence-based resources I listed with my prior comments should be consulted by those interested in this topic.
A recent conversation I had with a reporter illustrates the point. She had just utilized a concierge, personalized clinic that required two days of evaluation and cost $2,500. After hearing about the tests performed and the advice she received, I expressed my belief that much of it was of questionable value and that the same result could probably have been achieved in much less time with a good family history and lifestyle review, tailored risk-reduction advice, those screening tests recommended by the U.S. Preventive Services Task Force, and recommended vaccines.
I have enjoyed rereading the article by Drs. Snyderman and Yoediono; they make many excellent observations. I still feel it reflects uncritical confidence in the expected benefits of genomics, insufficient consideration of potential harms of unproven interventions, and a failure to acknowledge that most of the personalized services they described currently lack evidence of effectiveness, and risk diverting attention and money from much more potent public health interventions. Hopefully, our dialogue will help academic medicine lead in creating a health care system that includes universal access to evidence-based, prevention-oriented services and avoidance of nonbeneficial and costly care.
Doug Campos-Outcalt, MD, MPA
Associate head, Department of Family and Community Medicine, and assistant dean for outreach and multicultural affairs, University of Arizona College of Medicine, Phoenix, Arizona; (firstname.lastname@example.org).