Direct to consumer genetic testing and personalized medicine: Achieving public health goals

How can the rapidly advancing field of personalized medicine, and direct-to-consumer genetics in particular, serve the goals of public health? At first glance, the terms “personalized” and “medicine” would seem to be inconsistent with public health, relating to individuals rather than populations and with the medical care system rather than the public health system. Indeed, the growth of new tools for medicine might widen health disparities if this growth results in widening access between the medical “haves” and “have-nots” and if marketing that targets racial or ethnic groups tends to reify false notions of genetic determinism of traits associated with racial or ethnic groups. How might we assure that research, translation and implementation in this area are oriented toward disease prevention and health promotion for populations and the reduction of health disparities? Strategies might include (1) addressing the rise of direct-to-consumer marketing and availability of genomic tools by working with the relevant industries and the media, while advocating for reasonable regulation; (2) Applying what we're learning about individualized risk to the strengthening of public health programs to prevent chronic disease and reduce environmental harms; (3) addressing issues of access to avoid widening health disparities; (4) promoting public awareness through media and K-12 education; and (5) applying the Public Health Code of Ethics to personalized medicine practice and policy.