title: Precision Medicine, Cardiovascular Disease and Hunting Elephants.
abstract: Precision medicine postulates improved prediction, prevention, diagnosis and treatment of disease based on patient specific factors especially DNA sequence (i.e., gene) variants. Ideas related to precision medicine stem from the much anticipated "genetic revolution in medicine" arising seamlessly from the human genome project (HGP). In this essay I deconstruct the concept of precision medicine and raise questions about the validity of the paradigm in general and its application to cardiovascular disease. Thus far precision medicine has underperformed based on the vision promulgated by enthusiasts. While niche successes for precision medicine are likely, the promises of broad based transformation should be viewed with skepticism. Open discussion and debate related to precision medicine are urgently needed to avoid misapplication of resources, hype, iatrogenic interventions, and distraction from established approaches with ongoing utility. Failure to engage in such debate will lead to negative unintended consequences from a revolution that might never come.
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905. Electronic address: joyner.michael@mayo.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Joyner
mesh_terms: D002317:Cardiovascular Agents / Q000191:economics / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics / Q000235:genetics* / Q000628:therapy*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004059:Diffusion of Innovation; D005544:Forecasting; D005819:Genetic Markers; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D015316:Genetic Therapy / Q000191:economics / Q000379:methods* / Q000639:trends; D023281:Genomics / Q000191:economics / Q000379:methods* / Q000639:trends; D017048:Health Care Costs; D006801:Humans; D018579:Patient Selection; D010597:Pharmacogenetics; D010641:Phenotype; D057285:Precision Medicine / Q000379:methods* / Q000639:trends; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D002317:Cardiovascular Agents; D005819:Genetic Markers
keywords: Clinical research; Genomics; Precision medicine