Non-precision Medicine for Maximum Impact

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headshot of Dr. Jonas

Wayne B. Jonas, MD, President and CEO, Samueli Institute

In health care and in science, there are lumpers and then there are splitters. Scientists tend to be splitters, dissecting different aspects of a disease, different parts of your brain receptors, and looking for different effects on different organs. Then, they look for drugs that inhibit those different parts form the basis for a medical treatment. Nobel Prizes and profits are based on splitting up the body into finer and finer parts down to a cell and its genome and showing that they have broad implications.

The advance of convergence of genomics and technology allows us to take this splitting to a new level.

The latest term for this type of medicine is “precision medicine.” Recently there’s been a suggestion that precision medicine is the most important advance possible for creating health in the population.

Advances of precision medicine are lifesavers for specific individuals with a chronic illness, in which a particular underlying genetic cause can be identified.

Have We Taken A Wrong Turn?

But many cell-specific advances don’t help the majority of the population. Precision medicine doesn’t tackle the core issues affecting public health: prevention of cancer, heart disease, diabetes and chronic stress. The potential for widespread impacts in public health are not found in identifying a specific genetic cause, or metabolic pathway for their condition. Instead, we need to focus on broad lifestyle changes that can affect the vast majority of the population.

The solution is about implementing and applying what we already know impacts 70 percent of chronic disease.

Dean Ornish, MD, demonstrated this in a dramatic fashion years ago and he still continues to do so today as he looks at the fundamental factors of disease prevention and applies them as treatment. These include exercise, food, stress management, and the social and economic factors that help people live a healthy life. When applied intently and intensively to individuals, it’s not just preventive, it’s therapeutic. These solutions are cheaper and have wider impact than drugs focused at genetic targets.

The Value of Non-Precision Medicine

The value in population health is not identifying the specific cause and treatment of a condition on factors that will have the greatest value, but rather factors that have the greatest value for the greatest number of people.

These solutions are non-precise. In fact, they’re general.

Recently, Dr. Ornish demonstrated that the same lifestyle principles he applied years ago to cardiovascular disease, also seemed to help mitigate and treat cancer. These same factors are now known to affect diseases such as obesity, diabetes, stroke, and others. The strength of these factors is that they benefit a wide array of chronic illness—their impact lies in their imprecision.

While precision medicine may be invaluable to individuals with unique genetic patterns, what we need first is the efficient application of non-precision medicine on the health population (and on the population in general) as a treatment approach. Precision medicine should only be used after the maximum application of non-precision medicine. Then, we’ll have an optimized and efficient system that’s both the most cost-effective and widely impactful.