Will Genomics Widen or Help Heal the Schism Between Medicine and Public Health? Review Article

We discuss the “schism” between medicine and public health in light of advances in genomics and the expected evolution of health care toward personalized treatment and prevention. Undoubtedly, genomics could deepen the divide between the two worlds, but it also represents an important and perhaps unique opportunity for healing the schism, given the volume of new scientific discoveries and their potential applications in all areas of health and disease. We argue that the integration of genomics into health care and disease prevention requires a strong medicine–public health partnership in the context of a population approach to a translational research agenda that includes four overlapping areas: (1) a joint focus on prevention—a traditional public health concern but now a promise of genomics in the realm of individualized primary prevention and early detection, (2) a population perspective, which requires a large amount of population-level data to validate gene discoveries for clinical applications, (3) commitment to evidence-based knowledge integration with thousands of potential genomic applications in practice, and (4) emphasis on health services research to evaluate outcomes, costs, and benefits in the real world. A strong medicine–public health partnership in the genomics era is needed for the translation of all scientific discoveries for the benefit of population health.