关注精准医疗是否会偏离寻求人类健康良方的道路？

  近年来研究者对精准医疗的关注越来越多，但对精准医疗越来越多的关注或许并不能解决困扰人类健康的一些持续性问题。
  近日，刊登在国际杂志NEJM上的一篇报道中，来自哥伦比亚大学和波士顿大学的研究者在文章中指出，精准医疗投入的增加或许并不会解决美国正在面对的人类健康的不公平现象；今年总统奥巴马宣布了一项2.15亿美元用于资助精准医疗的计划，旨在开发更多的靶向疗法，开展这项研究计划是因为精准医疗可以为临床实践及人类的健康带来巨大贡献。
  为了改善公众健康，研究者表示，我们同时也不得不关注并且解决美国的社会经济及种族的不平等性，因为这些因素会使得公众健康变得更加糟糕。相比其它高收入国家而言，目前总体的美国人口都面对着较差的健康措施，比如不良分娩结局、肥胖及心脏疾病等；其它研究也支持该观点，比如在英国，人群医疗保健的花费并不是接受疗法的障碍，而且他们目前仍然在健康上存在社会的不平等性。
  研究者指出，当前美国在投入上相比其它国家要少，整个国家仍然在努力减少贫穷及居住隔离模式，这可以有效改善人群较差的健康表现。文章中研究者表示，精准医疗可以改善患者的临床护理，但我们需要警惕的是，这种精准医疗或许仅仅适合于进行治疗因遗传决定的一系列机体疾病。
  最近来自NIH的一项报告指出，相比其它疾病预防相关的计划而言，和基因组相关的计划可以获得至少50%以上的资金支持；最后研究者说道，在没有减少精准医疗对临床护理的潜在意义的基础上，我们依然担心未来精准医疗计划的实施是否可以真正为广大人群带来疾病治疗的福利及机体的健康监护。（转化医学网360zhyx.com）
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转化医学网推荐的原文摘要：

Public Health in the Precision-Medicine Era
NEJM    DOI: 10.1056/NEJMp1506241
Ronald Bayer, Ph.D., and Sandro Galea, M.D., Dr.P.H.
That clinical medicine has contributed enormously to our ability to treat and cure sick people is beyond contention. But whether and to what extent medical care has transformed morbidity and mortality patterns at a population level and what contribution, if any, it has made to the well-being and life expectancy of the least-advantaged people have been matters of contention for more than a century. This debate has taken on renewed importance as the scientific leadership at the National Institutes of Health (NIH), National Academy of Medicine, and U.S. universities have taken up the challenge of personalized or precision medicine. It is a challenge given all the more salience by President Barack Obama's announcement in his State of the Union address that his administration would seek to fund a major new initiative. Responding to the President's words, Harold Varmus, director of the National Cancer Institute, and Francis Collins, director of the NIH, have written that “What is needed now is a broad research program to build the evidence base needed to guide clinical practice.”1
The enthusiasm for this initiative derives from the assumption that precision medicine will contribute to clinical practice and thereby advance the health of the public. We suggest, however, that this enthusiasm is premature. “What is needed now” is quite different if one views the world from the perspective of the broad pattern of morbidity and mortality, if one is concerned about why the United States has sunk to the bottom of the list of comparable countries in terms of disease experience and life expectancy, or if one is troubled by the steep social gradient that characterizes who becomes sick and who dies. The burgeoning precision-medicine agenda is largely silent on these issues, focusing instead on detecting and curing disease at the individual level.
So is this approach indeed “What is needed now”? Our skepticism about what precision medicine has to offer is predicated on both a reading of the evidence regarding social determinants of population health and recognition of what that evidence means for the priorities that should guide our investments to advance public health and reduce health inequities.