Hope Tempered by Caution: Public Beliefs in the USA about the Benefits and Drawbacks of Using Epigenetic Technologies in Clinical Care.

Abstract

Introduction: Clinical applications of epigenetic technologies could revolutionize precision medicine. However, successful uptake in clinical settings may be influenced by public opinion. We investigated public beliefs about possible benefits and drawbacks of epigenetic-based medical technologies.

Methods: We recruited 153 adults from across the USA to participate in 1 of 27 virtual focus groups, each lasting 45-75 min. Groups were stratified by education (less than bachelor's degree vs. bachelor's degree or more) and race and ethnicity (black or African American, Asian, Indigenous [Native Hawaiian, Pacific Islander, American Indian, Alaska Native], Hispanic, and white). Participants viewed an educational video about epigenetics prior to discussion. We used inductive and deductive qualitative content analysis.

Results: Participants indicated that epigenetic technologies could be used to guide risk-stratified prevention (i.e., engage in behaviors to reduce the risk of developing a health condition; engage in screening and early-detection behaviors to enable early treatment; facilitate clinical history-taking; inform reproductive planning decisions) and to develop novel therapeutics and editing approaches (i.e., new medications; epigenetic editing). However, participants also mentioned concerns about the ethical, legal, and social implications (ELSIs) of epigenetics, including exacerbating health disparities; the high cost of treatment and health insurance; promoting eugenics; and epigenetic-based discrimination by healthcare providers. Each of the race, education, and ethnicity strata included content related to each of the three major subthemes of risk-stratified prevention, novel therapeutics, and ELSI considerations.

Conclusion: Efforts to translate basic epigenetics research to clinical practice hold promise, but it is also critical to create solutions that address people's concerns.