Personal Genomics and Public Health
Dr. Neil W. Schluger's main area of academic interest has been in tuberculosis, including clinical trials, molecular epidemiology, development and evaluation of diagnostics, and human host immune responses. He is the principal investigator at Columbia University for the Tuberculosis Trials Consortium, a CDC-funded collaboration in clinical trials in which patients are enrolled in trials of treatment of latent tuberculosis infection and active tuberculosis disease. In addition, Dr. Schluger has led studies examining the transmission dynamics of tuberculosis in New York City, using tools of molecular epidemiology. He has a long standing interest in the development and evaluation of new tools for the diagnosis of tuberculosis.
More recently, in addition to his studies in tuberculosis, he has led clinical trials for the use of retinoids in the treatment of emphysema and for the use of interferon gamma in the treatment of idiopathic pulmonary fibrosis.
Question: Will personal genomics play a bigger role in public health?
Neil Schluger: And so that’s a great question because I think personal genomics to me exists in a sort of tension with public health because public health by definition is a discipline that focuses on populations and not individuals. Medicine in a sense is what focuses on individuals. Someone gets sick, you take care of them, but from a public health perspective we ask the question what can be done medically, legally, economically, culturally, socially to improve the health of a population? And that might be building a sewer system instead of having an open water supply or it could be things like making cigarettes illegal or hard to get, and so those things I think are in some sort of tension with ideas like personal genomics. I’m a big believer in public health. I think you can make a dollar go a long way. We have the luxury in the United States because we’re a wealthy country of being able to do all this personalized medicine but I doubt that sort of personal genomics kind of approaches will have much impact on a disease like TB, at least not for many, many years
Question: What about diseases with genetic components, like malaria?
Neil Schluger: There certainly is a genetic predisposition to malaria but again I think it’s going to be difficult there. The scale of the infection is just enormous. Tens of millions of people get infected with malaria every year. It’d be hard for me to believe any time in the foreseeable future that genetic medicine will have much to do with control of malaria. If you had-- People point this out. If you have a dollar to spend right now on malaria, you’re better off spending it buying a bed net to be honest.
Recorded on: 04/25/2008
Public health, Schluger says, deals with populations, not individuals.
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