Personalized Genomic Medicine and Health Care Justice

Posted by ELSI Contributor on October 27, 2009

This commentary in the Genomics Law Report’s ongoing series What ELSI is New? is contributed by Michelle L. McGowan Ph.D., Case Western Reserve University Department of Bioethics.

The most significant challenge to the promise of personalized genomic medicine hinges on the realization of health care justice. From a social justice perspective, meeting the basic health care needs of the population – locally and globally – is an urgent objective that dwarfs the goal of a genomic approach to medicine.

The challenge to proponents of personalized genomic medicine is to find a way to frame their aspirations and actions in a way that simultaneously moves towards realizing personalized medicine and global health care justice. However, the terminology and current direction of personalized medicine has the potential to hinder this effort.

To date the promotional rhetoric of personalized medicine has emphasized how access to one’s genomic information will be personally empowering, that it can lead to individually tailored prescriptions and therapies, and that knowledge of genomic risk susceptibilities can prompt preventive health measures and curb the manifestation of disease. The underbelly of these promises is its individualist orientation which invokes a neoliberal ideology toward health with obliges personal responsibility for health management.

This approach seems painfully out of step with the social debates on how to achieve access to basic health care for the population as a whole. It seems to me that the promise of individually-tailored health services can best be achieved in a context in which the entire population is ensured access to basic health care, because without it the realization of personalized medicine has the potential to further exacerbate existing health disparities and generate new forms of health inequities.