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Muinkhoury

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  • 1. “ Welcome to the Genomic Era” Guttmacher and Collins, NEJM 2003;349:996
  • 2. “ Welcome to the Genomic Era” Guttmacher and Collins, NEJM 2003;349:996
    • 1953-2003
    • DNA 50 th Anniversary
  • 3. How Will Genetics Change Our Lives 50 Years from Now?
  • 4. How Will Genetics Change Our Lives 50 Years from Now?
    • “ We will have individualized, preventive medical care based on our own predicted risk of disease as assessed by looking at our DNA. By then each of us will have had our genomes sequenced because it will cost less than $100 to do that. And this information will be part of our medical record. Because we will still get sick, we'll still need drugs, but these will be tailored to our individual needs.
      • F. Collins MD, PhD, TIME, the Future of Life, 2003 
  • 5. How Will Home Computers Look like 50 Years from Now?
  • 6. How Will Home Computers Look like 50 Years from Now?
      • Popular Mechanics Magazine (1954)
  • 7. In the Meantime: What Can Public Health Do Today?
  • 8. In the Meantime: What Can Public Health Do Today?
    • Gene-Environment Interaction
    • Public Health Training
    • Use of Family History as a Health Promotion Tool
  • 9. Human Diseases Result from Gene-Environment Interaction
    • “ Some vegetarians with 'acceptable' cholesterol levels suffer myocardial infarction in the 30's. Other individuals...seem to live forever despite personal stress, smoking, obesity, and poor adherence to a Heart Association-approved diet"
    R.A. Hegele (1992)
  • 10. Genetics and Cardiovascular Disease Lp(a) Health Status Diabetes LDL Smoking Cholesterol Blood Pressure Obesity Exercise Triglycerides Homocysteine Fibrinogen Stress Nutrition Insulin GENES
  • 11. Nature vs. Nurture?
    • “ There are two causes of asthma, the environment and genetic variants. Each accounts for about 50 per cent of the risk of disease”
      • Cookson W and Moffat M. Making sense of asthma genes. Editorial NEJM 2004;351: 1794
  • 12. Nature vs. Nurture?
    • “ There are two causes of asthma, the environment and genetic variants. Each accounts for about 50 per cent of the risk of disease”
      • Cookson W and Moffat M. Making sense of asthma genes. Editorial NEJM 2004;351: 1794
  • 13. Nature & Nurture
    • “ 100% of any disease is environmentally caused and 100% of any disease is genetic. Any other notion is based on a naive view of causation”
      • Rothman K. Modern Epidemiology 1986
  • 14. “ Genes, Behavior, and the Social Environment: Moving Beyond the Nature/Nurture Debate”
    • “ Recent knowledge is pushing scientists to look beyond single agents of health and disease. By breaking out of their disciplinary “silos” and embracing a broader systems view, based on the understanding that health outcomes are the result of multiple determinants—social, behavioral, and genetic--that work in concert through complex interactions, the best health outcomes from research may be yet to come”
    • Institute of Medicine Report August 2006
  • 15. “ Sick Individuals and Sick Populations” G Rose (1986)
    • Population approach vs high risk approach: do we have to choose?
    • “ Realistically, many diseases will long continue to call for both approaches, and fortunately competition between them is usually unnecessary"
  • 16. Institute of Medicine, 2002 8 Critical Areas for Public Health Education in the 21 st Century
  • 17.
      • Informatics
      • Genomics
      • Communication
      • Cultural competence
      • Community-based research
      • Global health
      • Policy and law
      • Public health ethics
    Institute of Medicine, 2002 8 Critical Areas for Public Health Education in the 21 st Century 90% US public health schools teach policy but only 15% genomics
  • 18. Everyday Choices for a Healthier Life
    • Eat Right
    • Get Active
    • Don’t Smoke
    • See Your Doctor
  • 19. Everyday Choices for a Healthier Life
    • Eat Right
    • Get Active
    • Don’t Smoke
    • See Your Doctor
  • 20. Everyday Choices for a Healthier Life
    • Eat Right
    • Get Active
    • Don’t Smoke
    • See Your Doctor
    • “ One size fits all” campaigns have not worked well so far
    • Can we do personalized health promotion based on varying levels of susceptibility?
  • 21. Everyday Choices for a Healthier Life
    • Eat Right
    • Get Active
    • Don’t Smoke
    • See Your Doctor
    • How many people in this room have a first degree relative (child, parent or sibling) with cancer, heart disease, stroke or diabetes?
  • 22. Everyday Choices for a Healthier Life
    • Eat Right
    • Get Active
    • Don’t Smoke
    • See Your Doctor
    • Heart disease 2.0 – 5.4
    • Breast cancer 2.1 – 3.9
    • Colorectal cancer 1.7 – 4.9
    • Prostate cancer 3.2 – 11
    • Melanoma 2.7 – 4.3
    • Type II diabetes 2.4 – 4.0
    • Osteoporosis 2.0 – 2.4
    • Asthma 3.0 – 7.0
    FHX RR Yoon et al. Am J Prev Med 2003
  • 23. Everyday Choices for a Healthier Life
    • Eat Right
    • Get Active
    • Don’t Smoke
    • See Your Doctor
    • Know Your Family History
  • 24. Everyday Choices for a Healthier Life
    • Eat Right
    • Get Active
    • Don’t Smoke
    • See Your Doctor
    • Know Your Family History
      • Independent risk factor
      • Interactive risk factor
      • Only rarely about “genetic diseases”
      • Can enhance early disease detection
      • Promotes family-centered interventions
      • Enhances interaction with providers
      • Will have a population health impact
  • 25. Everyday Choices for a Healthier Life
    • Eat Right
    • Get Active
    • Don’t Smoke
    • See Your Doctor
    • Know your family history
  • 26. Use of Family History Today as a Health Promotion Tool Can Have a Population Health Impact
    • Almost half the population has a family history of a
    • close relative with one or more common chronic diseases (Scheuner, 1997)
    • 14% of families account for almost half of
    • the burden of heart attacks in Utah (Hunt 2003)
    • More than 70% of adults with diabetes have a family history of diabetes (Hariri et al, 2005)
    • Using family history for early detection can double the number of prevented colorectal cancer (Tyagi and Morris, 2003)
  • 27. Family Health History Average Moderate High Standard prevention recommendations Personalized prevention recommendations Personalized prevention recommendations & r eferral for genetic evaluation Risk stratification Intervention Assessment Family history Risk Stratification Concept
  • 28. Public Health Utility of Family History
    • “ Family History effectively bridges clinical medicine with public health by focusing risk assessment at a level between the extremes of “one at a time” and “one size fits all”
      • Hunt S, et al. Am J Prev Med 2003;24:136.
  • 29. “ Nature, Nurture or Both” R. Hoover NEJM 2000
    • "Perhaps it is time to drop the competition implied by talking about a debate over nature versus nurture in favor of efforts to exploit every opportunity to identify and manipulate both environmental and genetic risk factors to improve the control of cancer"

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