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基因组学会扩大还是有助于弥合医学与公共卫生之间的分歧?

Will genomics widen or help heal the schism between medicine and public health?

作者信息

Khoury Muin J, Gwinn Marta, Burke Wylie, Bowen Scott, Zimmern Ron

机构信息

National Office of Public Health Genomics, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, USA.

出版信息

Am J Prev Med. 2007 Oct;33(4):310-7. doi: 10.1016/j.amepre.2007.05.010.

Abstract

We discuss the "schism" between medicine and public health in light of advances in genomics and the expected evolution of health care toward personalized treatment and prevention. Undoubtedly, genomics could deepen the divide between the two worlds, but it also represents an important and perhaps unique opportunity for healing the schism, given the volume of new scientific discoveries and their potential applications in all areas of health and disease. We argue that the integration of genomics into health care and disease prevention requires a strong medicine-public health partnership in the context of a population approach to a translational research agenda that includes four overlapping areas: (1) a joint focus on prevention-a traditional public health concern but now a promise of genomics in the realm of individualized primary prevention and early detection, (2) a population perspective, which requires a large amount of population-level data to validate gene discoveries for clinical applications, (3) commitment to evidence-based knowledge integration with thousands of potential genomic applications in practice, and (4) emphasis on health services research to evaluate outcomes, costs, and benefits in the real world. A strong medicine-public health partnership in the genomics era is needed for the translation of all scientific discoveries for the benefit of population health.

摘要

我们根据基因组学的进展以及医疗保健向个性化治疗和预防发展的预期趋势,探讨医学与公共卫生之间的“分裂”。毫无疑问,基因组学可能会加深这两个领域之间的分歧,但鉴于新科学发现的数量及其在健康和疾病各个领域的潜在应用,它也代表了弥合这种分裂的一个重要且或许独特的机会。我们认为,将基因组学融入医疗保健和疾病预防需要在以人群为基础的转化研究议程背景下建立强大的医学 - 公共卫生伙伴关系,该议程包括四个重叠领域:(1)共同关注预防——这是传统的公共卫生关注点,但如今也是基因组学在个性化一级预防和早期检测领域的前景所在;(2)人群视角,这需要大量的人群层面数据来验证基因发现以便用于临床应用;(3)致力于将基于证据的知识与数千种潜在的基因组学实际应用相结合;(4)强调卫生服务研究以评估现实世界中的结果、成本和效益。为了将所有科学发现转化以造福人群健康,在基因组学时代需要强大的医学 - 公共卫生伙伴关系。

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