The Progression of Health Care From Personalized Medicine to Wellness Genomics and Beyond
The reorientation of precision health into wellness genomics has brought up several important ethical questions for members of the healthcare community.
The reorientation of precision health into wellness genomics has brought up several important ethical questions for members of the healthcare community. Researchers tracked this progression in an article published in the AMA Journal of Ethics.
The progression from personalized medicine to wellness genomics as mapped by researchers began with pioneering work on the molecular genetic code. The first notions of genetic engineering appeared in the 1960s, with scientists hoping for a future where splicing DNA would lead to gene therapies that could help eradicate diseases at the molecular level.
In the 1990s, mapping and sequencing the whole human genome became the focus, with the term personalized medicine emerging for the idea that physicians would someday personalize each patient's pharmaceutical interventions and lifestyle prescriptions according to the person's unique genomic profile. By 2013, the personalized medicine label had become precision medicine, partly to include the possibility of its use across the larger population rather than only on an individual level.
In some cases, precision medicine was rebranded as precision health through efforts by public health officials and healthcare institutions. This change incorporated population sciences, allowing the goals of the work to translate between individual and population levels with ease. From precision health comes the umbrella of wellness genomics. This name change reflects some of the goals for health applications of genomic research: wellness, living longer lives, and thriving.
Research in the arena of wellness genomics includes identifying genetic variants associated with the superlative end of our species' phenotypes to better understand human biology. In today's marketplace there are already many wellness genomics laboratories offering commercial testing for some genetic variants, such as for athletic talent or resistance to certain diseases. Although many are hopeful about the future of this work, the ethical implications of gene editing and the gray area between prevention and enhancement remain to be explored.
As for the next relabeling of these efforts, the authors noted that the current progression of names offers some possible clues to the direction that they will turn. All of the names so far, they wrote, offer values, goals, and assumptions that shape how those who use the labels think and act.
Juengst ET, McGowan, ML. Why does the shift from “personalized medicine” to “precision health” and “wellness genomics” matter? AMA J Ethics. 2018;20(9):E881-E890.