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• W2083024871 abstract "The United States spends $2 trillion per year on health care, 2 to 3 times per capita than that of other developed nations.1 Despite this staggering financial investment, our citizens have a lower life expectancy than those in many other countries,1,2 and it has been reported that patients receive only about half the evidence-based care that they should.3 To lead us out of this dilemma, the National Institutes of Health (NIH) have set national health research funding priorities to investigate approaches that are predictive, personalized, preemptive, and participatory—the “4 P’s.”4,5 These words represent succinct talking points that have broad appeal. However, source documents suggest that the vast majority of NIH dollars will be steered toward technological interventions,4,6 especially pharmacogenetics. The NIH’s version of the 4 P’s curiously ignores another important “P”: prevention.Central to views of prediction and preemption are identifying individual genetic risks and developing pharmacogenetic treatments that would preempt disease before it starts. These are exciting and promising areas of research. However, although the United States already leads the world in high-tech health care, it trails in most indicators of population health.1,2 This is, in part, because NIH research has been focused predominantly on the evaluation and treatment with technological interventions of the individual patient.6 To produce societal impact, prevention and health care programs need to be disseminated through and work in systems and populations6,7 and attend to the economic, social, and behavioral determinants of population risk and health. Applying the results of individual-based research to population-based public health issues and health policy has several problems7,8 and can result in an overestimation of benefits and an underappreciation of the risks and costs.As NIH pursues research on the 4 P’s, it is hoped that the approach will be transdisciplinary and will consider the public health implications of various solutions so that we can narrow the gap between research and practice. For example, predictive research should include behavioral and environmental risk factors, including socioeconomic and policy issues.6 Personalized medicine should include approaches that are truly patient-centered, such as the tailoring of behavioral interventions, and should address health literacy, and other communication barriers, as well as personal, family, and cultural preferences and values. Collaborative, preventive (rather than preemptive) research should include primary prevention, behavioral, community, policy, and environmental approaches. Participatory approaches should involve research conducted in real-world settings and should respect the contributions of all stakeholders, including clinicians, patients, and citizens. Finally, both research and research applications occur in contexts, and study of contextual factors is essential to judge applicability and relevance.6,7It is also important that the 4 P’s include broad-based approaches that integrate successful contributions from public health and the behavioral and social sciences, such as reducing smoking prevalence and promoting screening and treatment for high blood pressure, which have substantially reduced the rates of heart disease over the past 50 years. A major NIH investment, the Diabetes Prevention Program,9 showed that modest weight loss and physical activity could reduce diabetes onset by 58% among those at high risk." @default.
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• W2083024871 date "2007-11-01" @default.
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• W2083024871 title "National Institutes of Health Science Agenda: A Public Health Perspective" @default.
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• W2083024871 doi "https://doi.org/10.2105/ajph.2007.118356" @default.
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