From time to time, it's nice to rediscover I'm not the only cynic in the room. So I was obviously relieved to see a couple of criticisms of the latest orthodoxy about the future practice of medicine. The question is: Is the Precision Medicine Initiative the real deal or just another government gamble on the ponies?
Rita Rubin writes in the March 17 issue of the Journal of the American Medical Association that the hyperbole surrounding the President's Precision Medicine Initiative (or PMI) has raised a few eyebrows, albeit for different reasons. Rubin cites Jeffrey Matthews, chair of the department of surgery at the University of Chicago, as arguing that the title of the program exceeds the program's likely reach.
Matthews is said to have stated that precision medicine sounds great on paper, but "it is being oversold and overhyped, and it's creating unrealistic expectations on the part of patients and clinicians." Of course PMI is far from alone in this, as the much-ballyhooed Critical Path Initiative and the parallel review program run by FDA and CMS make clear.
Big data maven Eric Topol of the Scripps Translational Science Institute is credited with a skepticism of a different brand. Rubin quotes Topol as saying, "the science is catapulting forward" toward precision medicine, but that genetic sequencing fills in only one layer of the picture.
"If you really want to change medicine, you have to have all the information on the individual," Topol stated, making the argument that even information on the bacterial environment in the gut is necessary to leverage this new medical paradigm. Topol may be right, but one has to ask whether it's even remotely plausible to economically come up with that much information.
Not to take a shot at Topol, but sooner or later, someone will ask whether the relationship between the individual and his or her parents is essential to a true personalized/precision medicine paradigm. That's how we'll know for certain that all this emphasis on precision has gone too far.
The past as epilogue
Another point of consideration is that the PMI calls for the collection of data on a million Americans and the use of smart phones and so on to evaluate the interaction between genes and other factors, such as environmental factors.
We might note that government finally (and mercifully) pulled the plug on the National Children's Study and that bisphenol A has been pretty much exonerated from any culpability where human disease is concerned. The National Children's Study suffered from no shortage of ambition or of bogeymen, and we might ask ourselves if the Precision Medicine Initiative, relying as it will on electronic health record interoperability, is likely to meet the same fate, especially given that lifestyle is still a big – maybe the biggest – factor in declining health.
Time will tell, but I'd point out that betting against government's blind ambitions does not routinely result in a bad day at the horse track.