By Derek Yach
President Obama launched the new National Institutes of Health (NIH) Precision Medicine Initiative on Friday by highlighting how advances in precision medicine have already led to many peoples lives being saved. He invoked the American spirit of innovation, while stating that the most important impact of precision medicine was not to be measured in terms of dollars but in terms of helping people live long and healthy lives. Bipartisan support was evident. Patient support groups applauded. Pharmaceutical companies and researchers praised the president.
Amidst such hype supported by so many powerful intellects and interests it seems almost crass to question whether this is the best way forward to tackle the health of all Americans. But is it? With limited dollars available for health research, will other important areas be neglected while untold millions are dedicated to precision medicine?
It would be different if Obama were to announce a similar and complementary initiative to fund research into the prevention of non-communicable diseases (NCDs). The World Health Organization estimates NCDs such as heart disease, lung disease and diabetes account for 88 percent of total deaths in the United States. Thats more than 2 million people each year! Yet, a recent analysis of NIH research by the Vitality Institute and the American Heart Association confirms a decadal long neglect of investment by the NIH in prevention science.
Finding ways to prevent heart disease, lung disease and diabetes could close the preventive and social gaps that dominate the problems with the American health system. Further, many NIH innovations from the past — including some highlighted by President Obama — fail to be implemented across the country, contributing to the continued underperformance of the worlds most expensive health system.
It is important to emphasize that the NIH does not just fund research projects. NIH funding is used to build the current and future cadre of health and medical scientists and leaders. Those leaders views influence the priorities of government on health and their advocacy frames the public and media discourse on what is needed to improve health. Greater support for precision medicine and breakthrough cures means greater advocacy and focus on those cures and treatment at the cost of prevention, health promotion and approaches needed to reduce inequalities.
This is the time to build on the American spirit of innovation to create a national culture of health that places prevention, health promotion and the reduction of inequalities at its core. Today, our increased life expectancy creates new challenges that will require the full implementation of what we have learned from science and public health experience. Diseases, especially those linked to longevity like cognitive impairments and musculoskeletal disorders, require better insights into effective prevention and cost-effective management.
Precision medicine has its role in the American health system. But it must not be allowed to distort the focus of attention of efforts to improve the health of all Americans. The visible proof of how some new treatments work for a few needs to be balanced against the invisible millions who never applaud the quiet permanent success of prevention and the many who have yet to feel the benefits of breakthrough cures made over the last five decades.
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