For several decades now the biomedical research community has pursued a narrative positing that a combination of ever-deeper knowledge of subcellular biology, especially genetics, coupled with information technology will lead to transformative improvements in health care and human health. In this Viewpoint,we provide evidence for the extraordinary dominance of this narrative in biomedical funding and journal publications; discuss several prominent themes embedded in the narrative to show that this approach has largely failed; and propose a wholesale reevaluation of the way forward in biomedical research…<\/p>\n
In 1999, Collins envisioned a genetic revolution in medicine facilitated by the Human Genome Project and described 6 major themes: <\/div>\n
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- \ncommon diseases will be explained largely by a few DNA variants with strong associations to disease, <\/div>\n<\/li>\n
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this knowledge will lead to improved diagnosis; <\/div>\n<\/li>\n- \n
such knowledge will also drive preventive medicine; <\/div>\n<\/li>\n- \n
pharmacogenomics will improve therapeutic decision making; <\/div>\n<\/li>\n- \n
gene therapy will treat multiple diseases; and <\/div>\n<\/li>\n- \n
a substantial increase in novel targets for drug development and therapy will ensue.<\/div>\n<\/li>\n<\/ul>\nThese 6 ideas have more recently been branded as personalized or precision medicine. Similarly, there is the increasing interest in and expectation that: <\/div>\n- \n
- \nstem cell therapy—a seventh theme—can treat common diseases.<\/div>\n<\/li>\n<\/ul>\nTo avoid the misconception that big ideas are all related to biological sciences, an eighth theme is: <\/div>\n
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- \nthe emphasis in the narrative on the clinical and research value of converting medical records to electronic formats. <\/div>\n<\/li>\n<\/ul>\nAs of April 2016, the Centers for Medicare & Medicaid Services had paid $34 billion in financial incentives to service providers for implementing electronic health record [EHR] systems. EHRs are an important aspect of this narrative because they are thought to provide the structural underpinnings of precision medicine. It has been suggested by some that some combination of these 8 big ideas will yield substantial cost savings for health care…<\/div>\n<\/blockquote>\n
What they go on to say is that these big ideas haven’t panned out, have consumed research funds well beyond any usefulness, have become inappropriately self perpetuating, and that it’s time to put them on the shelf and move on to other pastures<\/font><\/em>.<\/strong><\/p>\n
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