September 22, 2016

The common goal of precision medicine and public health


Dr. Eric B. Larson pulls ideas from The Lancet, JAMA, and Science to explain why population-based medicine is personalized medicine.

by Eric B. Larson, MD, MPH, Group Health Research Institute (GHRI) executive director, and Group Health vice president for research

Recent editorials in science journals have been debating precision medicine vs. public health. Precision, or personalized medicine, individualizes care based on patients' characteristics such as their genetics, behavior, and environment. Public health focuses on the health of whole populations. But these fields aren't that different. In fact, I believe that population-based medicine can be highly personalized.

A recent Journal of the American Medical Association viewpoint, “Will precision medicine improve public health?,” summarizes the issues. In this commentary, Drs. Muin Khoury, Centers for Disease Control and Prevention, and Sandro Galea, Boston University School of Public Health, present affirmative and negative cases for the question they pose.

Drs. Khoury and Galea conclude that the way forward for precision medicine and public health researchers is thoughtfully combining knowledge from the two areas to improve population health. This is also the recommendation of Sue Desmond-Hellmann, chief executive officer of the Bill & Melinda Gates Foundation. Her editorial in Science, “Progress lies in precision," calls for enlisting the principles of precision medicine in the service of public health.

Where epidemiology and precision medicine meet

The personalized side of public health occurred to me when reading “The urgent need to rehumanise science,” in The Lancet, by editor-in-chief Dr. Richard Horton. His premise is that epidemiologists, who study disease at a population level, don’t have a reputation as warm-hearted humanitarians. Although our work is for the general public good, he writes, we must strive to stay aware of the plight of individuals. Dr. Horton recommends absorbing the works of great writers about human suffering such as Michael Herr and Elie Wiesel, who both died this summer.

I agree that experiencing thought-provoking books, art, and other culture gives meaning to our work and lives. But as a researcher and practitioner of epidemiology and population-based medicine, I believe they are, by their very nature, deeply personal sciences because they are about real people and their everyday lives.

Toward a population of one

At GHRI, we use big datasets and epidemiological and statistical methods to discover patterns in the diseases and health of large populations. This approach sounds cold and insensitive, like we are looking for one-size-fits-all solutions. But, in fact, the opposite is true.

The goal of population-based medicine is to give each person the best chance of staying healthy, and if we get sick, to provide the most likely diagnosis, treatment, and follow-up plan to make us well. We want to take the guesswork out of medicine so you get the best advice based on what we know works for most people. Population-based medicine doesn’t stop there, though.

Paradoxically, our research on the biggest, most diverse populations possible is what lets us draw the most individualized conclusions. Working with data on large groups allows us to do subgroup analyses. We look at how age, sex, and other factors affect disease, diagnosis, and treatment to achieve more specific health guidance. At GHRI, our research seeks the most precise treatments for individuals with the goal of achieving the best health for everyone.

GHRI is also a leader with Group Health in incorporating shared decision making into clinical care. For example, we’re national leaders in promoting the use of video and print decision aids to help physicians and patients objectively weigh the personal risks and benefits of preference-based treatments like elective surgery. By adding individual priorities to population-based treatment recommendations, we aim to get to a population of one: you.