By Samuel W. Anderson

from GeneWatch 28-1 | Jan-May 2015

As the cost of genome sequencing continues to drop, the concept of personalized medicine has received a great deal of attention. There is certainly cause for excitement when we imagine a not too distant future in which patients' treatments can be specifically tailored to match the peculiarities of their genome. However, as you will read in the following pages, there are some big-picture applications of genome sequencing which haven't been getting the buzz of personalized medicine. For starters, genomics is about much more than developing treatments. Muin Khoury puts it succinctly: "Although personalized treatments can help save the lives of people who are already sick, disease prevention applies to all of us."

And so this issue of GeneWatch focuses on public health genomics. Khoury has plenty to say on the subject - he's the Director of the CDC's Office of Public Health Genomics. Yet, for all the promise of these new applications, he will agree with a primary theme in this issue, and in much of the discussion of public health genomics today: Before we get too excited, let's not forget that just because we increasingly can prescribe genomic technologies to large groups of people doesn't mean we always should. For example, Susan Klugman and Siobhan Dolan look at the fast-approaching possibility of combining non-invasive prenatal screening with whole genome sequencing: "When these two technologies collide, there is great promise that risk-free diagnoses can be made early in pregnancy." Yet they quickly point out that when this is applied to all pregnant patients as a routine procedure, the stress and anxiety it introduces may contain more risks than benefits. As James Evans puts it: "Genomics holds potential for great public health benefits, especially in heading off certain severe but preventable diseases, but we must be careful about inflicting our favorite medical interventions on those who are already healthy."

Still, Evans points out, there really is reason for excitement about public health genomics; perhaps in contrast with personalized medicine, public health measures can present great benefit to the greatest number of people. "Stunning successes like vaccines and fluoridated water attest to the power of public health and dwarf the small good that I do in my medical office treating one sick patient at a time."

Samuel Anderson is Editor of GeneWatch.

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