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Cathy Schoen, Robin Osborn, Phuong Trang Huynh, Michelle Doty, Karen Davis, Kinga Zapert, and Jordan Peugh, Primary Care And Health System Performance: Adults’ Experiences In Five Countries, Health Affairs Web Exclusive, October 28, 2004 [Abstract] [PDF] [HTML Version][Media Briefing and Q & A] [Reprints & Permissions]

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Genomics and Primary Care: Eve of the Revolution

David W. Moskowitz, M.D.   ( 29 October 2004 )

Genomics and Primary Care: Eve of the Revolution 29 October 2004
David W. Moskowitz, M.D., CEO and CMO GenoMed, Inc. Send letter to journal: Re: Genomics and Primary Care: Eve of the Revolution dwmoskowitz{at}genomed.com David W. Moskowitz, M.D.	It is not a surprise that primary care is the stepchild of American medicine. Blue Cross and Blue Shield, the first health plans, were established by surgeons in the 1920s to make sure they got paid for the operations they performed. Health plans have remained tied to hospitals ever since. The only way to spend 70% of health care dollars in the last 12 months of a patient's life, as we do in the U.S., is to spend it in the hospital, especially the ICU. Health plans simply pass on the costs; it's not their money. As long as every health plan does business the same way, health plans don't lose market share despite raising their premiums. In fairness, the hospital traditionally has been the place where medicine has joined battle with disease. That's all changing now with medical genomics. Medical genomics, the science of which genetic variations are responsible for which diseases, will provide an early warning system for each patient and make possible "personalized medicine." More importantly, it will make possible "preventive molecular medicine." For the first time, preventive medicine will be significantly more effective. Like hospital-based medicine, preventive medicine has so far been pretty underwhelming in terms of patient outcomes. Vaccines are less than perfect. Even with nicotine patches, only 25% of smokers quit. Obesity is notoriously hard to treat. But knowledge of a single gene may be able to delay or prevent as many as 150 common diseases. Imagine what will happen when we can accurately predict who's at high risk for the top 200 common diseases! Of course, it will be the PCP who will be running the show. Patients will be kept healthy and out of the hospital.