Genomic Medicine’s Help for Seniors Fighting Chronic
Disease Stuck in Bottleneck
Knowledge about genomic medicine way ahead of
incorporating it into clinical practice
Link to video below
March 19, 2008 – Using genomic medicine to treat or
even prevent chronic diseases cannot develop fast enough for millions of
senior citizens – the adults most likely to have such devastating
diseases. But, there is a bottleneck between what knowledge is available
about genomic medicine and incorporating it into clinical practice for
assessing the risk and battling such diseases as cardiovascular disease,
diabetes, and cancer, according to a systematic review in the Journal of
the American Medical Association.
The March 19 issue of JAMA is a theme issue on
Genetics and Genomics.
Maren T. Scheuner, M.D., M.P.H., of the RAND
Corporation, Santa Monica, Calif., presented the findings of the study
at a JAMA media briefing at the National Press Club in Washington, D.C.
“The greatest public health benefit of advances in
understanding the human genome will likely occur as genomic medicine
expands from its focus from rare genetic disorders to inclusion of more
common chronic diseases, such as coronary heart disease, stroke,
diabetes mellitus, and cancer,” the authors provide as background
information in the article.
“With genomics discoveries relating to common
chronic diseases, numerous genetic tests may emerge that hold promise
for significant changes in the delivery of health care, particularly in
preventive medicine and in tailoring drug treatment.”
Dr. Scheuner and colleagues analyzed the medical
literature for research articles and systematic reviews published
between Jan. 2000 and Feb. 2008 dealing with common chronic adult-onset
conditions.
Advances In Genetic Medicine Are Great But Some
Healthcare Workers Are Not Ready To Deliver These Services
March 19, 2008 - Genetic testing can now help
identify more than a thousand genes that increase your risk for a number
of chronic and often fatal diseases. Advances in this field continue to
expand rapidly. But a new study finds some healthcare workers are not
ready to offer these services. Jennifer Mitchell explains in this week’s JAMA Report.
The authors included 68 articles in the analysis
and assessed four key areas: outcomes of genomic medicine, consumer
information needs, delivery of genomic medicine, and challenges and
barriers to integration of genomic medicine.
“Generally there were modest positive effects on
psychological outcomes such as worry and anxiety, behavioral outcomes
have shown mixed results, and clinical outcomes were less well studied,”
the authors report.
“The most important and consistent finding from our
literature review is that the primary care workforce, which will be
required to be on the front lines of the integration of genomics into
the regular practice of medicine, feels woefully underprepared to do
so.”
The authors note that consumers are unsure about
the value of genetic testing and have concerns about privacy issues and
discrimination in health insurance and employment. However, the
consumers were interested in the technology to help better identify
diseases for which they and their family members are at increased risk.
The analysis identified the need to better
understand the outcomes of genomic medicine interventions.
“More research describing clinical outcomes is
needed: do patients who receive counseling and testing have better
clinical outcomes in terms of mortality, decreases in incidence of
disease, and better clinical responses to pharmaceuticals? And at what
cost?”
Other barriers to the clinical integration of
genomic medicine for common chronic diseases were identified by these
authors in addition to the perceived inadequacy of the primary care
workforce.
“The most prominent of these include health
professionals’ lack of basic knowledge about genetics and their lack of
confidence in interpreting familial patterns of disease, which limits
their ability to appropriately counsel their patients, order and
accurately interpret genetic tests, and refer their patients for
genetics consultation.”
In conclusion, the authors write: “It will be a
lost opportunity if the health services research components of genomic
medicine fail to keep pace with the rapid basic science advances and
clinical discoveries.”
Editor's Note: This work was funded by the Health
Services Research and Development Service, part of the Department of
Veterans Affairs’ Office of Research and Development.
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