“Are the current public health strategies evidence-based?”. That was the
central question posed by Angela Brand, keynote speaker at GRE2007. Her
answer: “No, since we are not including results from genomics research.”
Brand is director of the German Centre for Public Health Genomics at the
University of Applied Sciences in Bielefeld, Germany. She set out to
convince her audience that the outcome of genomics research should be
used to develop new strategies to promote health and prevent diseases in
populations. Brand gave the example of obesity: “Various strategies have
been developed for obesity, but in fact we have no idea what we are
doing.”
Molecular indications
Genomics could result in significant cost savings in healthcare, Brand stated. “Currently interventions are started when symptoms appear. Genomics should make it possible to treat a patient earlier, when molecular indications appear.” Such a pre-emptive strategy could be developed in the case of. e.g., rheumatoid arthritis, for which recently three involved genes were discovered. Brand also has high expectations of personalized medicine. She mentioned the example of warfarine, an anticoagulant that reduces the risk of stroke and heart attacks. Genetics should make it possible to determine for every individual patient exactly how much of this drug should be administered. Finally, Brand expects that genomics will make health care more predictive.
Remaining challenges
At the end of her presentation, Brand touched on some remaining
challenges in this field. The relation between a genetic defect on one
hand and a certain disease on the other hand can be complicated. After
all, it is possible that different genetic variations lead to the same
disease. In addition, it is also possible that one genetic variant can
play a role in different diseases, e.g. in obesity, asthma and
non-Hodgkin lymphoma. The effects can even be opposing, as is the case
for the ACE-gene, in which a deviation leads to a risk for stroke and
simultaneously protects against Alzheimer. Brand: “This means that
health care should shift from disease-orientation to disease-clusters
and health-outcome.” She thinks public healthcare should react faster to
results from genomics research. Brand: “Now we are often five to ten
years behind. I think that we should react more immediately to the
trends that we see.”
[Els van den Brink]
