A Population Approach to Precision Medicine

Overview

Journal Am J Prev Med

Specialty Public Health

Date 2012 May 22

PMID 22608383

Citations 61

Authors

Muin J Khoury

Marta L Gwinn

Russell E Glasgow

Barnett S Kramer

Affiliations

Soon will be listed here.

Abstract

The term P4 medicine is used to denote an evolving field of medicine that uses systems biology approaches and information technologies to enhance wellness rather than just treat disease. Its four components include predictive, preventive, personalized, and participatory medicine. In the current paper, it is argued that in order to fulfill the promise of P4 medicine, a "fifth P" must be integrated-the population perspective-into each of the other four components. A population perspective integrates predictive medicine into the ecologic model of health; applies principles of population screening to preventive medicine; uses evidence-based practice to personalize medicine; and grounds participatory medicine on the three core functions of public health: assessment, policy development, and assurance. Population sciences-including epidemiology; behavioral, social, and communication sciences; and health economics, implementation science, and outcomes research-are needed to show the value of P4 medicine. Balanced strategies that implement both population- and individual-level interventions can best maximize health benefits, minimize harm, and avoid unnecessary healthcare costs.

Citing Articles

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References

Knoppers B, Hudson T . The art and science of biobanking. Hum Genet. 2011; 130(3):329-32. DOI: 10.1007/s00439-011-1067-9. View

Gulcher J, Stefansson K . Genetic risk information for common diseases may indeed be already useful for prevention and early detection. Eur J Clin Invest. 2010; 40(1):56-63. DOI: 10.1111/j.1365-2362.2009.02233.x. View

Barry M . Screening for prostate cancer--the controversy that refuses to die. N Engl J Med. 2009; 360(13):1351-4. DOI: 10.1056/NEJMe0901166. View

Bloss C, Darst B, Topol E, Schork N . Direct-to-consumer personalized genomic testing. Hum Mol Genet. 2011; 20(R2):R132-41. PMC: 3179383. DOI: 10.1093/hmg/ddr349. View

Khoury M, McCabe L, McCabe E . Population screening in the age of genomic medicine. N Engl J Med. 2003; 348(1):50-8. DOI: 10.1056/NEJMra013182. View

Iglehart J . Prioritizing comparative-effectiveness research--IOM recommendations. N Engl J Med. 2009; 361(4):325-8. DOI: 10.1056/NEJMp0904133. View

Manolio T, Green E . Genomics reaches the clinic: from basic discoveries to clinical impact. Cell. 2011; 147(1):14-6. DOI: 10.1016/j.cell.2011.09.012. View

Beskow L, Khoury M, Baker T, Thrasher J . The Integration of Genomics into Public Health Research, Policy and Practice in the United States. Community Genet. 2001; 4(1):2-11. DOI: 10.1159/000051150. View

Khoury M . From genes to public health: the applications of genetic technology in disease prevention. Genetics Working Group. Am J Public Health. 1996; 86(12):1717-22. PMC: 1380723. DOI: 10.2105/ajph.86.12.1717. View

10.

Hamburg M, Collins F . The path to personalized medicine. N Engl J Med. 2010; 363(4):301-4. DOI: 10.1056/NEJMp1006304. View

11.

Seminara D, Khoury M, OBrien T, Manolio T, Gwinn M, Little J . The emergence of networks in human genome epidemiology: challenges and opportunities. Epidemiology. 2006; 18(1):1-8. DOI: 10.1097/01.ede.0000249540.17855.b7. View

12.

Hood L, Friend S . Predictive, personalized, preventive, participatory (P4) cancer medicine. Nat Rev Clin Oncol. 2011; 8(3):184-7. DOI: 10.1038/nrclinonc.2010.227. View

13.

Frieden T . A framework for public health action: the health impact pyramid. Am J Public Health. 2010; 100(4):590-5. PMC: 2836340. DOI: 10.2105/AJPH.2009.185652. View

14.

Fielding J, Teutsch S . An opportunity map for societal investment in health. JAMA. 2011; 305(20):2110-1. DOI: 10.1001/jama.2011.698. View

15.

Moasser M . Targeting the function of the HER2 oncogene in human cancer therapeutics. Oncogene. 2007; 26(46):6577-92. PMC: 3071580. DOI: 10.1038/sj.onc.1210478. View

16.

Collins F . Shattuck lecture--medical and societal consequences of the Human Genome Project. N Engl J Med. 1999; 341(1):28-37. DOI: 10.1056/NEJM199907013410106. View

17.

McGuire A, Burke W . An unwelcome side effect of direct-to-consumer personal genome testing: raiding the medical commons. JAMA. 2008; 300(22):2669-71. PMC: 2789655. DOI: 10.1001/jama.2008.803. View

18.

Evans J, Khoury M . Evidence based medicine meets genomic medicine. Genet Med. 2007; 9(12):799-800. DOI: 10.1097/gim.0b013e31815bf9b5. View

19.

Galea S, Riddle M, Kaplan G . Causal thinking and complex system approaches in epidemiology. Int J Epidemiol. 2009; 39(1):97-106. PMC: 2912489. DOI: 10.1093/ije/dyp296. View

20.

McGinnis J . Can public health and medicine partner in the public interest?. Health Aff (Millwood). 2006; 25(4):1044-52. DOI: 10.1377/hlthaff.25.4.1044. View