title: Narrowing the gap of personalized medicine in emerging countries: the case of multiple endocrine neoplasias in Brazil.
abstract: The finished version of the human genome sequence was completed in 2003, and this event initiated a revolution in medical practice, which is usually referred to as the age of genomic or personalized medicine. Genomic medicine aims to be predictive, personalized, preventive, and also participative (4Ps). It offers a new approach to several pathological conditions, although its impact so far has been more evident in mendelian diseases. This article briefly reviews the potential advantages of this approach, and also some issues that may arise in the attempt to apply the accumulated knowledge from genomic medicine to clinical practice in emerging countries. The advantages of applying genomic medicine into clinical practice are obvious, enabling prediction, prevention, and early diagnosis and treatment of several genetic disorders. However, there are also some issues, such as those related to: (a) the need for approval of a law equivalent to the Genetic Information Nondiscrimination Act, which was approved in 2008 in the USA; (b) the need for private and public funding for genetics and genomics; (c) the need for development of innovative healthcare systems that may substantially cut costs (e.g. costs of periodic medical followup); (d) the need for new graduate and postgraduate curricula in which genomic medicine is emphasized; and (e) the need to adequately inform the population and possible consumers of genetic testing, with reference to the basic aspects of genomic medicine.
authors.affiliation: Endocrine Genetics Unit, Endocrinology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. toledorodrigo@usp.br
authors.forename: Rodrigo A
authors.initials: RA
authors.lastname: Toledo
authors.forename: Tomoko
authors.initials: T
authors.lastname: Sekiya
authors.forename: Viviane C
authors.initials: VC
authors.lastname: Longuini
authors.forename: Flavia L
authors.initials: FL
authors.lastname: Coutinho
authors.forename: Delmar M
authors.initials: DM
authors.lastname: Lourenço
authors.forename: Sergio P A
authors.initials: SP
authors.lastname: Toledo
mesh_terms: D001938:Brazil; D018276:Carcinoma, Medullary / Q000175:diagnosis / Q000235:genetics*; D018278:Carcinoma, Neuroendocrine; D003695:Delivery of Health Care / Q000191:economics*; D030661:Genetic Privacy / Q000331:legislation & jurisprudence; D005820:Genetic Testing / Q000191:economics* / Q000331:legislation & jurisprudence; D006801:Humans; D007348:Insurance, Health / Q000331:legislation & jurisprudence; D009377:Multiple Endocrine Neoplasia / Q000175:diagnosis / Q000235:genetics*; D009154:Mutation / Q000235:genetics*; D010282:Parathyroid Neoplasms / Q000235:genetics; D057285:Precision Medicine; D017149:Private Sector; D017150:Public Sector; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000235:genetics*