Abstract
It can be hard to predict what awaits us in 2021, though the leaders of four industry trade groups—the Personalized Medicine Coalition, the American College of Medical Genetics and Genomics, the Association for Molecular Pathology, and the National Society of Genetic Counselors—were intrepid enough to do just that this issue. (See 2021 Preview, page 36).
Which is why I found it curious when a colleague forwarded me a report from management consulting firm Oliver Wyman that simply didn't look one or two years into the future of genomics, rather 10 years.
The report begins with a broad statement: “Genomics is evolving from niche to center stage. Harnessing it will transform our daily lives, disrupt payer, provider, and pharma business models, and create new markets for next-generation prevention.”
I'd agree that in 2020 the use of genomics is moving more to the fore for both patient care and in providing information that can help people stay healthy—the long-awaited emergence of well-care. I'm not convinced, however, that genomics in the next 10 years will transform our daily lives. If I'm the one to go out on a limb, I think the application of genomics will simply bubble in the background. It will be more easily accessed (Wyman predicts the cost of whole-genome sequencing will be in the $10 to $50 range by then), but for the vast majority of people, it won't affect their lives. It will simply be available when needed.
Of the report's six predictions, one that jumped out at me was “electronic health records (EHRs) will become EHGRs, or electronic health and genetics records.” That's a pretty big transformation for an industry dominated by just a few major players who, until now anyway, have been very slow to react to the use of genomics in healthcare. But I'll go along with this one, especially since a recent conversation with Marc Williams, director of the Genomic Medicine Institute at Geisinger Health, indicated that the health system is in the early days of testing just such a module provided by their EHR vendor.
That same prediction ends with a whopper, though. “Every primary care provider will need to provide genetic counseling.” To me this is not a practical evolution of how healthcare is provided, or even could be provided. Primary care providers are generalists who refer to specialists like cardiologists or neurologists for focused care. Geneticists and genetic counselors will serve the same role as specialists, and providers will know when it is appropriate to make that referral.
In short, the continued rise of genomics won't make us all genetics experts, just as the broad adoption of cell phones didn't make us all telecommunications experts. But, like cellphones changed how we communicate, genomics will significantly change how we treat human health and disease.