Will genomics erode public health and prevention? A scenario of unintended consequences in the Netherlands

Abstract

In Dutch health policy, new visions of future healthcare paradigms have been articulated over the past decade, where a multi-disciplinary knowledge base is expected to feed into prevention and treatment, responding to socio-economic health pressures whilst configured around the individual patient’s needs. However, in parallel, life sciences research has undergone changes since the completion of the Human Genome Project. Increased knowledge of the human genome is expected to enable the development of drugs tailored to individual genotype, and improve treatment of chronic disorders. With much attention and science funding focused on the expected, but largely uncertain, contributions of genomics to healthcare, one may ask if we are witnessing unintended consequences, i.e. the slow erosion of public health and prevention? This paper uses colorectal cancer (also called colon or rectal cancer) genomics to demonstrate how visions of ‘personalized healthcare’ have been created around genomics that are essentially uncertain, while ongoing genomics funding affects other life science areas aligned with prevention. We sketch out better approaches to expectations management based on scenario building and policy coordination.