In 2007, we published a paper entitled: “Will genomics heal or widen the schism between medicine and public health?” We explored the long standing split between medicine and public health and how the emergence of genomics and other technologies can affect it. The “schism” was identified by Kerr White in his 1991 book in which he described a growing gap between individual- and population-based approaches to improving health in the 20th century. Kerr stated “today, the two cultures “medicine and “public health” seem to live in different, often unfriendly worlds”. Advances in genomics are fueled by the investigation of biological mechanisms of disease, leading to personalized treatment. On the other hand, public health emphasizes the study of environmental and social influences on health and disease, focusing on health promotion and disease prevention.
A blog devoted to discussing best practices and questions about the role of genomics in disease prevention, health promotion and healthcare.
Selected Category: genomics
August 21st, 2014 3:41 pm ET - Muin J Khoury, Director, Office of Public Health Genomics, Centers for Disease Control and Prevention
Nobody is average but what to do about it? The challenge of individualized disease prevention based on genomics
July 2nd, 2014 12:51 pm ET - Muin J Khoury, Director, Office of Public Health Genomics, Centers for Disease Control and Prevention
Each week, Garrison Keillor shares with National Public Radio listeners the latest news from Lake Wobegon where “all the women are strong, all the men are good looking, and all the children are above average.” The concept of “average” is deeply rooted in our scientific analysis of all health related traits such as height, weight and health indicators (such as blood sugar, cholesterol) and in assessing the likelihood of developing disease. There are several ways to measure average such as mean, median and mode that reflect different approaches towards evaluating central tendencies. For every characteristic, we graph the distribution values in the population (e.g. the Normal distribution, see figure) and quantify averages and variation in values in the “population” and its various subgroups.
May 15th, 2014 1:08 pm ET - Muin J Khoury, Director, Office of Public Health Genomics, Centers for Disease Control and Prevention
In the United States, the 5 leading causes of death are heart disease, cancer, chronic lower respiratory diseases, cerebrovascular diseases (stroke), and unintentional injuries. On May 2, 2014, the Centers for Disease Control and Prevention released an MMWR report on the annual number of potentially preventable deaths from these 5 causes in the United States. The data suggest that at least a third of those deaths every year are potentially preventable. The analysis compared the number of observed deaths in each state with an expected number that is based on average death rates for the three states with the lowest rates for each cause. States in the Southeast had the highest number of potentially preventable deaths. Therefore, potentially a large health impact may be achieved if states with higher rates were able to reduce the prevalence of risk factors for leading causes of death to the average of the three lowest states. Nevertheless, press coverage of this important report tended to sensationalize and overinterpret the results of these types of analyses with statements like “Living in the Southeast is bad for your health”; or “lifespan to do more with geography than genetics”.
April 3rd, 2014 12:21 pm ET - W. David Dotson, Office of Public Health Genomics, Centers for Disease Control and Prevention
Michael P. Douglas, Office of Public Health Genomics, Centers for Disease Control and Prevention
Katherine Kolor, Office of Public Health Genomics, Centers for Disease Control and Prevention
Previously, CDC’s Office of Public Health Genomics announced a list of health-related genomic tests and applications, stratified into three tiers according to the availability of scientific evidence and evidence-based recommendations and systematic reviews. The list is intended to promote information exchange and dialogue among researchers, providers, policy makers, and the public.
Initially the table relied on generalized examples of how genomic applications could be classified among tiers. We planned to expand it, however, populating it with specific examples. The table grew quickly, and previous blogs describe the addition of specific cancer genomic tests and family history applications. Then we moved on to include pharmacogenomics tests in the table and that’s where things got really interesting!
March 20th, 2014 1:45 pm ET - Muin J Khoury, Director, Office of Public Health Genomics, Centers for Disease Control and Prevention
On March 5-6, 2014, I attended the 7th annual Future of Genomic Medicine (FoGM) conference [PDF 778.13 KB], hosted by Dr. Eric Topol at the Scripps Translational Science Institute. The audience included more than 500 participants from various fields including genomics, clinical medicine, laboratory medicine, industry, economics, social and communication sciences, patients and the press. The gathering featured a cast of outstanding presenters and panelists including Craig Venter, former Vice President Al Gore, the patient from the future [PDF 778.13 KB] and many others [PDF 778.13 KB]. This was an enthusiastic audience of early adopters who are working tirelessly to make the vision of genomic medicine a reality.
March 6th, 2014 10:51 am ET - Scott Bowen, Office of Public Health Genomics, Centers For Disease Control and Prevention
Announcing New Tier 1 CDC Public Health Genomics Toolkit and Video Resources
Impact… Scalability… Innovation… Evidence-based interventions… Surveillance and evaluation… Partnerships… Timely information to health care, the public, and decision makers… Commitment… These elements are crucial to any public health accomplishment and are recurring themes in 2 new public health genomics resources.
Nearly 2 million people in the United States are at increased risk for adverse health outcomes due to one of the following conditions Lynch syndrome (LS), hereditary breast/ovarian cancer (HBOC), and familial hypercholesterolemia (FH). Because, at present, these conditions are poorly ascertained by the healthcare system, many individuals and families affected by them are not aware that they are at risk; however, early detection and intervention could significantly reduce morbidity and mortality. Because of their unique ability to partner, facilitate, and provide leadership across the health sector, public health departments have important roles to play in reducing the burden of these conditions.
Public health genomics implementation to save lives – from national vision to state success is a video produced in partnership with Genetic Alliance featuring prominent public health and health care provider, payer, and patient leaders. The web available program provides a scope that moves from the national vision for impact to actual achievement in one specific state example: Michigan. The video includes a primary focus on LS and HBOC and includes specific key steps to be taken, the crucial importance of partners, lessons learned, results, and next steps.
February 13th, 2014 2:33 pm ET - Guest Blogger
Alison Stewart Guest Blogger, and Muin J. Khoury, Director, Office of Public Health Genomics, Centers for Disease Control and Prevention
A general practitioner recently writing in the BMJ, said that evidence-based medicine is polluted with “fraud, sham diagnosis, short term data, poor regulation, surrogate ends, questionnaires that can’t be validated, and statistically significant but clinically irrelevant outcomes”, all leading to “overdiagnosis and misery”. In more temperate tones, Goldberger and Buxton recently suggested in a JAMA Viewpoint article that personalized medicine and guideline-based medicine “present conflicting priorities”, with evidence-based guidelines derived from clinical trial data failing to recognize the heterogeneity of the patient population to which they will be applied. The existence of these guidelines then acts, they say, as a barrier to the development of personalized approaches that would be more appropriate for different population subgroups – including those likely to gain no benefit from the intervention.
February 13th, 2014 2:33 pm ET - Guest Blogger
Alison Stewart, Guest Blogger and Muin J. Khoury, Director, Office of Public Health Genomics, Centers for Disease Control and Prevention
In a previous blog post, Michael Douglas and David Dotson from our office asked the question “So what are health care providers to do today when considering ordering a genomic test to diagnose, prevent or ameliorate a medical condition?” If we set aside the “genomic” bit of this for a moment, and think about how a health care provider might come to a decision about using any kind of medical test, the answer might well be that he or she would look to see whether any professional practice guidelines had been published that were relevant to the clinical situation in which use of the test was being considered.
January 30th, 2014 3:43 pm ET - Muin J Khoury, Director, Office of Public Health Genomics, Centers for Disease Control and Prevention
At the end of each year, we read about top lists of major events, accomplishments, and milestones. These lists are produced by journal editors, institutions and opinion leaders. CDC is no exception. In December 2013, CDC published its top 5 accomplishments for 2013, which include the Tips from former smokers campaign, outbreak investigations featuring pathogen sequencing and advanced molecular detection, the Million Hearts® initiative, eliminating healthcare-associated infections, and celebrating 10 years of the global program to fight HIV/AIDS. Similar lists in other areas of science and technology have been published (for example, see Science and Nature.
Genome Sequencing in the Clinic – The question is not whether the glass is half-full or half-empty but whether or not the glass is the right tool.
December 12th, 2013 2:42 pm ET - Guest Blogger
W. Gregory Feero, MD, PhD, Maine Dartmouth Family Medicine Residency
Earlier this fall, the Blue Cross Blue Shield Technology Evaluation Center produced a report [PDF 210.52 KB] evaluating the clinical use of exome sequencing in the diagnosis of rare diseases. That this report was even generated is remarkable, as it marks an appreciable level of penetration by exome sequencing into clinical care. A decade ago, sequencing and interpreting even the small portion of the human genome that the exome represents would have been cost-prohibitive. Now, clinical grade exome sequencing with interpretation can be obtained for around $5-10,000. This is still a relatively big price tag but it is well within an order of magnitude of what insurers cover for many diagnostic tests. The Blue Cross report signals that sequencing with next-generation, high-throughput technologies has progressed in the minds of many from strictly a research endeavor into the realm of clinical reality.
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