Prevention, precision prevention and precision medicine.

Abstract

It has been proposed that the measurement of the sequence of exposures an individual is exposed to over time (or "expotype," complementary to the genotype) would be a way to promote precision medicine at the patient's bed, and also primary prevention. The incorporation of new technologies, like omics, genotypes, Electronic Health Records, georeferencing and AI, into public health is attractive; however, the thesis of this Commentary is that the use of the exposome approach for precision prevention needs to be examined critically. The use of the expotype for practical purposes requires proof of causality, and the added value of the expotype may be limited, for example if measured through the NNT (Number Needed to Treat). In addition, the medical system may not afford the extra budgets to measure the expotype at the patient's bed (particularly if it goes beyond the anamnesis and georeferencing, and includes omic measurements). I also argue that public health is largely a matter of structural interventions at the societal level, like taxation, and not only of individual responsibility. The main successes in tackling diseases have been tobacco taxation, sugar taxes and of course vaccination, rather than individualized health promotion. The proposal of extending precision therapy to precision prevention should not divert our attention from the great opportunities for prevention at the population level. Population prevention is cheaper, it usually addresses several diseases with a single intervention (think of smoking or air pollution) and does not need to be replicated at each generation like cure.