From Hope to Reality in Personalized Medicine

Continued from page 1

I was hoping that Collins would offer a more frank assessment of where we stand on the road to a true age of personalized medicine--what's worked and what hasn't.

Which leads to my second issue with The Language of Life--that Collins does not draw on his experience and provide us with a plan for closing the wide gap between our genomic-challenged world and Hope's hoped-for future.

Collins does outline the bare bones of an agenda for pushing society forward into a true age of personalized health. He calls for an increase in funding for research (not surprising coming from the director of the NIH); better use of electronic medical records to collect data that can be used to develop predictive models for disease; improvements in policy to facilitate a more rapid progression from research to applications for patients; an emphasis on education, especially for physicians and other medical caregivers; and finally, a more robust bioethical discussion about potentially controversial innovations.

I understand the need to keep explaining genomics until the public gets it. And Collins uses his folksiness and charm to great effect as he patiently explains one more time what exactly a nucleotide is, and how having an A rather than a G might predispose one to a high risk for colon cancer. At some point, however, the discussion needs to shift to a realistic blueprint for action. Only then will the public get the lesson--when genetics ceases to be an abstraction and becomes relevant to their lives.

The third gripe I have with the book is its overwhelming emphasis on genomics as being the language of life. I'm surprised by this, given that Collins has championed several programs at the NIH that are trying to integrate genomics with other key components that make a person who they are, and that have powerful impacts on disease, behavior, and other traits.

Chief among these nongenomic influences on human life is a person's environment--everything from diet to UV rays and chemical toxins such as mercury and pesticides. Each of us is born with a genetic blueprint, but this is meaningless for most common diseases without understanding the interaction of the environment and our personal genetic proclivities for either sensitivity to or protection from assaults from the world we live in.

Collins mentions the role of the environment and other crucial factors that affect our health, including proteomics and the trillions of microbes in our bodies, but only in passing.

In 2006, Collins wrote The Language of God: A Scientist Presents Evidence for Belief, which had the same accessible style as Life. A devout Christian, Collins analyzed and dismissed the arguments of those who deny evolution and who oppose on religious grounds embryonic stem-cell research. Collins said that for him, God and biology are compatible--and that God's handiwork can be seen in the workings of every cell, nucleotide, and stem cell that scientists work with in their labs.

Collins engaged a wide audience with that first book as it settled onto the New York Times bestseller list for several weeks. In part, this was because of the topic--the eternal tussle to reconcile faith and science. But Collins's book also resonated because he clearly articulated a path forward for people who were struggling with what seemed to be a contradiction between faith and science.

I'm hoping Collins writes a Language of Life II that takes a similar tack: moving beyond explanation and enthusiasm to also articulate a clear path forward, so that the hope for personalized medicine he describes in those final pages can become a reality.