Common Sense on Personalized Medicine, Stress

Two thought-provoking commentaries appeared today in the Journal of the American Medical Association, one questioning the long-term significance of genomic information in personalizing health care, and the other stressing the role that stress plays in causing disease.

University of Washington researchers Wylie Burke and Bruce Psaty suggest that minor genetic differences between people account for very few cases of common diseases. The most famous example, the BRAC1 and BRAC2 mutations that are associated with just 15 percent of breast cancer cases, is far more prevalent than most genetic markers. Most are associated with just a few percentage points of a disease. The authors conclude:

Given the uncertainties of risk prediction and the small effect size of most genetic risk factors for common diseases, predictive genetic testing is likely to play only a modest role in the prevention of these diseases, with relatively little medical care improved by knowledge of a patient's genetic profile.

They conclude their essay with a plea for doctors to return to the real personalized medicine -- the indispensable one-on-one care that provides psychic relief along with professional care.

Sheldon Cohen of Carnegie Mellon University and colleagues, meanwhile, find that major life events like natural disasters, economic downsizing and bereavement increase the likelihood of depression, cardiovascular disease, progression to AIDS for HIV-positive people, and cancer. They call for clinical trials showing that reducing these stressors reduce disease.

While it is welcome that an article in JAMA aimed at the nation's physicians recognizes the role that social conditions play in promoting disease, anyone who has paid attention to the studies knows that income inequality and class status are negatively correlated with health and longevity. But do we really need more clinical trials to prove that interventions work, or do we need social programs that reduce the stress that promotes disease?

What people in New Orleans needed was a FEMA that worked, not another clinical trial showing that people who lose their homes and get no help get sick and die at much faster rates than those for whom care is provided.