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- Published: 19 July 2024
What will it take to make precision health a global reality
Nature Medicine volume 30 , pages 1793–1794 ( 2024 ) Cite this article
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As healthcare becomes more data-driven and precise, promising greater accuracy, targeted use of resources and healthier populations, we ask what it will take to realize these benefits in local and global contexts.
The word ‘precision’ has exploded across biomedical literature in recent years, but this approach is much more than a buzzword or trend. It is the natural evolution and modernization of healthcare, fuelled by the proliferation of data and increasingly powerful means for analyzing those data — which capture the enormous variation between people and their environments, as well as the microbes that colonize and infect them. This variation renders the ‘one size fits all’ approach to health and medicine inadequate, not just in terms of delivering equitable care to patients, but also in terms of building sustainable and efficient healthcare systems.
In this special issue , we ask what it means to deliver precision health — that is, tailoring preventive or treatment approaches to groups of people or individual people on the basis of certain characteristics — in different geographical and clinical contexts. Alongside the big questions addressing infrastructure, capacity, policy and access, our ‘Turning points’ articles zoom in on researchers’ personal stories of what precision health means to them, and how they came to dedicate their careers to this cause.
For clinician-scientist Shivani Misra, a case of misdiagnosed type 2 diabetes spurred a mission to better classify the heterogeneity of diabetes, especially in historically excluded populations. Misra notes that traditional, evidence-based recommendations (based on ‘average’ characteristics) fail many patients daily, but clinical biases and structural racism also have a role. Such biases may also be carried through medical records and other forms of data collection, making this a pervasive issue across clinical, research and computational contexts. Indeed, there are myriad opportunities for introducing or amplifying biases in electronic health records (EHRs) and other data sources, as noted by Marina Sirota and colleagues. EHRs represent an invaluable source of data for precision health research, but without appropriate collection, curation and analysis, efforts to harness these data could increase disparities even further. In their Review, they highlight emerging opportunities for harnessing EHR data and outline what responsible data curation looks like. It is a daunting but worthwhile task, one that epidemiological mathematician Juliane Fonseca de Oliveira is familiar with .
Working on the impressively scaled cohort of 100 million Brazilians, de Oliveira sees first-hand the value of diverse and well-curated datasets — from monitoring the impact of government policies on infectious disease control to identifying health effects of extreme climate events. This research exemplifies the concept of ‘precision public health’, whereby data are used to inform insights and interventions at the population level. Megan Roberts and colleagues review recent advances in this field and argue that precision approaches must be rooted in the basic concepts of public health — namely, assessment, policy development and assurance — and should engage the expertise of implementation scientists to ensure meaningful translation.
Genomics (both human and pathogen based) is a pillar of many precision health approaches, with oncology and infectious-disease surveillance being prime examples. But genomics capacity and EHRs — although mainstream in many high-income countries — are not universally embedded in health and research infrastructures worldwide. On the African continent, there is huge potential for precision approaches to help tackle the unique landscape of communicable and non-communicable diseases, but for this to be achieved, expansion of genomics capacity will be crucial, according to Christian Happi and colleagues. They outline a set of key strategies for advancing this goal, touching on issues spanning infrastructure, human capital, funding and policy. Commenting on other top priorities for low-and middle-income countries, Swartling and colleagues note that a focus on precision prevention and diagnosis may deliver the largest benefits. For example, several of the most common causes of child mortality first manifest as fever; therefore, digital tools for enhancing the classification and management of childhood fever could substantially reduce child mortality.
In regions in which research capacity is well developed and research is well funded, market failures and unsupportive policy environments can create a different set of problems. Research is producing effective gene and cell therapies for many rare diseases — most of which manifest in early childhood — but small market sizes (among other factors) make these commercially unattractive. To enhance access to these treatments for children in the USA, Crystal Mackall and colleagues propose a novel solution : the creation of a new entity that would fund itself, once established, and would conduct registrational trials, sponsor biological license applications and commercialize approved cell and gene therapies for children. Julia Pian, Timothy Yu and colleagues echo this call for change, particularly regulatory and legislative innovation, arguing that a reliance on philanthropy alone to fund such therapies is unsustainable.
Precision health is becoming big business, particularly in high-income countries in which tech companies seek to harness artificial intelligence 1 for a range of applications 2 for the prediction, prevention or treatment of disease. But to ensure that current health inequalities are not exacerbated, the precision health agenda must not be driven by big tech alone. Organizations such as UNICEF , WHO Africa and the Bill & Melinda Gates Foundation have recently acknowledged the potential of precision health approaches to address priority global health issues. But it is crucial that governments engage in these discussions to define priorities and supportive policies, armed with robust evidence from research. Standardized reporting of clinical studies evaluating precision approaches will be crucial for generating insights from collective research efforts and informing practice and policy decisions. To this end, the BePRECISE consortium presents a checklist tool and recommendations for reporting precision medicine research , with a focus on common complex diseases.
There is no doubt that the next generation of clinical medicine and public health will be more precise. The shift to precision approaches is well underway, and not just in healthcare; for example, precision agriculture involves the use of data, artificial intelligence, sensors and other techniques for targeted and efficient use of water, pesticides, and fertilizers 3 . In an age in which the interdependencies of climate, food security and health are glaringly obvious, data-driven precision approaches, if undertaken responsibly and equitably, could make health systems more resilient and sustainable, and help advance progress toward many of the Sustainable Development Goals.
Poon, H. Microsoft https://go.nature.com/4cKuoat (8 March 2024).
Balasubramanian, S. Forbes https://go.nature.com/3xvv4le (accessed 04 July 2024).
Soussi, A. et al. Sensors https://doi.org/10.3390/s24082647 (2024).
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What will it take to make precision health a global reality. Nat Med 30 , 1793–1794 (2024). https://doi.org/10.1038/s41591-024-03163-8
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MUSC shines spotlight on precision health, which research leader calls a top priority
The Medical University of South Carolina is putting precision health front and center, bringing together experts to talk about what it is, how it’s being used and what the future may hold. MUSC recently held a Precision Health Research Symposium, led by Lori L. McMahon, Ph.D. , vice president for Research and a professor of Neuroscience.
“The landscape of medicine and health care is undergoing significant transformation with precision health as a top priority. This evolution is a result of our deepening understanding of genomics and data science, which has opened the door for more precise, individualized health care,” McMahon said.
The event included speakers from MUSC, the University of Alabama-Birmingham, the HudsonAlpha Institute of Biotechnology, Helix and the Greenwood Genetic Center. They talked about the roles of data, genomics, research and systems in precision health.
Precision health through data
Matt Might, Ph.D., director of the Hugh Kaul Precision Medicine Institute at UAB, made a bold prediction: Historians will see data, a key aspect of precision health, as the biggest treatment of this century.
“I see precision medicine, really, as this field that delivers data as a drug. To do it right, precision medicine really needs computation. There's no way around managing the massive amounts of data from genomes to images without heavy intervention from computation.”
Computation is key, he said, in addition to other help from technology, including artificial intelligence. Mightgave a real-life example of how AI can improve patient care. It involved a 19-year-old woman named Kelsey who was suffering from intractable cyclic vomiting syndrome. “I think she was 5 feet, 4 inches tall, but weighed 75 pounds. She was severely malnourished at this point, suffering dozens of vomiting episodes per day,” Might said.
“Her medical team said, ‘Look, we've tried everything that we know about in this case, and nothing seems to be working.’ But everything they tried totaled 25 things. To be fair, 25 things is a lot. But it's not absolutely everything.”
So Might and his team, experts in precision medicine, put their technological skills to work. They used artificial intelligence to scan millions of medical research articles about nausea and unearthed a treatment that hadn’t been tried with Kelsey: nasally inhaled isopropyl alcohol.
To their relief, it worked. Kelsey’s life changed dramatically.
“If you fast forward eight months, not only has she not vomited since, but she was able to use this again to successfully arrest every episode of nausea. She was up to 125 pounds. And she was feeling well enough to get married,” Might said.
Precision health through genomics
Not every precision health story ends with a wedding but some do include life-changing diagnoses, treatments and more. And they begin, in some cases, with the use of genomics.
Genomics is the study of a person’s genes and how they interact with each other and the environment. Bruce Korf, M.D., knows a lot about that. He serves as associate dean for Genomic Medicine at the UAB School of Medicine and chief genomics officer.
Korf’s talk at MUSC focused on how genetic information can help patients, particularly people with rare diseases. Doctors refer patients to his team, which looks at their cases and when needed, performs genetic testing. That sometimes leads to a diagnosis that wasn’t obvious before. That, in turn, can lead to the right treatments.
And Korf sees an even greater role for genetic testing in the future – despite mixed public perceptions about it. “How do you get clinicians to use genetic and genomic testing in day-to-day practice? Some clinics are really eager to adopt genetic testing, while others are more hesitant,” he said.
As technological innovation, clinical utility, implementation and education continue to evolve, Korf said genomics and precision health will become more routine. “I think if you went to sleep and woke up in 20 years, you would not recognize the practice of medicine.”
And that could have big benefits, not only for people with rare diseases but also more common ones such as Parkinson’s and Alzheimer’s. Speaker Richard Myers, Ph.D., chief scientific officer, faculty investigator and president emeritus of the HudsonAlpha Institute for Biotechnology, talked about studying the genetics of neurodegenerative diseases. “It’s slow going but really important,” he said.
Also important, in his view: encouraging the public to participate in programs such as In Our DNA SC , a statewide effort to improve access to personalized health care and create a genetic and research database. Alabama has its own version . Both rely on the public’s willingness to get involved.
“Why do people participate in a population-facing component? They want to contribute to research and have an interest in their own future health. They want to help their children and grandchildren,” Myers said.
Precision health’s role in research
That idea of looking toward the future, a future with new health care options for a range of ailments, informs the work of researchers using precision health.
Several speakers talked about that, including Dan Judge, M.D., a professor in the College of Medicine at MUSC and the leader of In Our DNA SC . In Our DNA SC’s genetic and research database will help scientists for years to come. “We need to go from a disease-first to a gene-first approach. Let genetics lead the diagnosis,” Judge said.
Other scientists weighed in on the role of precision health in research by highlighting how they’re using it, including:
- Alain Greige, an M.D.-Ph.D. student of Neuroscience at MUSC. He’s working with Christopher Cowan, Ph.D., chair of the Department of Neuroscience, on an RNA-based approach to treating neurodevelopmental disorders.
- Steve Duncan, Ph.D., chair of Regenerative Medicine and Cell Biology at MUSC. He’s looking at possible treatments for a genetic disorder that causes high cholesterol levels.
- Saverio Gentile, Ph.D., associate professor in the Department of Cell and Molecular Pharmacology and Experimental Therapeutics at MUSC. He’s looking for new ways to target and treat cancer.
- John Wrangle, M.D., associate professor in the College of Medicine who treats patients in Hollings Cancer Center. He gave a broader take on the role of precision health in cancer research.
Precision health systems
These research projects wouldn’t be possible without a systematic approach. And as the name suggests, precision health requires precision when it comes to the systems needed to implement it.
Caitlin Allen, Ph.D. , an assistant professor in the Department of Public Health Sciences at MUSC and the director of Outreach and Implementation Research for In Our DNA SC, was among the speakers talking about getting systems in place to leverage precision health on a large scale, with attention paid to including everyone.
And representatives of Helix, a population genomics company and MUSC partner for In Our DNA SC, talked about standardizing the process of screening for health conditions. Nicole Washington, Ph.D., director of Research and Clinical Informatics at Helix, talked about a new approach. “The use of genomics in health care today is inefficient and inadequate. We need to change the model of how it’s done.”
Here's one way she suggested doing that when it comes to genomic screening. “Stop treating it like a one-off. We’re proposing going back into that sequence as much as possible for a patient’s lifetime. Sequence once, query often.”
Finally, representatives of the Greenwood Genetic Center, Rich Steet, Ph.D., and Heather Flanagan-Steet, Ph.D., discussed integrating research into clinical genetics care. Their South Carolina nonprofit provides genetic services, diagnostic testing, educational programs, resources and research into medical genetics. The partnership between GGC and MUSC combines the expertise of both organizations to expand services across the state and further their capability to improve prevention, diagnosis and treatment of diseases.
Precision health going forward
So what’s next? A lot, according to host McMahon. Precision health is an important part of the present and future of health care at MUSC and beyond.
“Harnessing the information in our DNA for research has the power to drive discoveries further and faster than ever before. With ever-advancing technologies, we are more equipped than ever to explore the intricacies of the human genome with unprecedented depth and precision,” she said.
“By studying the genetic variations among individuals and populations, we can uncover crucial insights into the causes and progression of diseases and ultimately inform potential treatment strategies now and for generations to come.”
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The first people settled in the region more than 30 thousand years ago. According to ancient legends, the coastal line was densely inhabited. In the Middle Ages, there were three empires on the territory of Primorye, which successively replaced each other: Bohai (698-926), Jin (1115-1234), Eastern Xia (1215-1233).
In the early 13th century, the territory of East Asia suffered the Mongol invasion. This led to the fall of the empire of Jin, but some provinces in the east preserved independence and formed an independent state known as Eastern Xia. In 1233, after another invasion this state ceased to exist too.
After that, the region was in ruins and attracted people persecuted in surrounding countries (bandits, adventurers, political dissidents). The first documented Russian presence in the region dates back to the summer of 1655, when the northern Primorye was visited by Russian Cossacks under the command of Onuphrius Stepanov.
In the middle of the 19th century, the Russian Empire began to strengthen its position in the north-west coast of the Pacific Ocean. In 1856, Primorskaya oblast was formed from the coastal parts of Eastern Siberia and Kamchatka. The territory of present Primorye was incorporated into the Russian state on the basis of Aigun (1858) and Beijing (1860) peace treaties that legalized the border between Russia and China.
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Since then, the southern part of Primorye took its current shape. In 1860, Vladivostok was founded as a military post. Russian migration in the region began. In 1899, the Oriental Institute was opened in Vladivostok - the first higher educational institution in Eastern Siberia and the Far East, and one of the oldest in East Asia.
Further strengthening of Russian positions in the Far East was limited by the small size of the Russian population and remoteness from populated parts of the empire. Regular communication between St. Petersburg and Vladivostok was established after the completion of the Trans-Siberian Railway in 1903.
From 1861 to 1917, about 250,000 peasants arrived in Primorye and founded 342 settlements. In 1917, the population of Primorye amounted to 307,000 people. By the mid-1920s, the local population reached 600,000 people. In the 1930s, forced industrialization and collectivization began which led to another wave of migration. The migration was both voluntary and forced (prisoners).
In 1937-1938, about 200,000 people of Korean and Chinese nationalities were forcibly deported from the region. Until the end of the 1980s, as a result of ethnic deportations, the Chinese and Koreans disappeared from the national composition of the population of Primorye.
In the summer of 1938, on the southern boundary of Primorye, in the area of Lake Khasan, there were military clashes between Manchukuo (a puppet state under Japanese control) and the Soviet Union. After two weeks of fighting, the USSR was able to repel the aggression. On October 20, 1938, Primorsky Krai with the capital in Vladivostok was formed.
After the end of the Second World War, Primorsky Krai continued to develop as a major industrial and agricultural region of the Far East also specializing in the extraction of natural resources. Rail and sea transport played a significant role in the local economy. Migration from the European part of Russia and Siberia continued, which led to an increase of population of the region from 1,381,000 people in 1959 to 1,978,000 in 1979.
With the collapse of the Soviet Union, the region’s economy went into decline, reverse migration in the European part of Russia began. At the beginning of the 21st century, the social and economic situation in Primorsky Krai improved.
Beautiful nature of Primorsky Krai
On the coast in Primorsky Krai
Author: Andrej Serbskij
Hilly landscape of Primorsky Krai
Author: Kazakov Igor
Primorye scenery
Author: Viktor Koblov
Primorsky Krai - Features
Primorsky Krai is located in the south of the Far East, in the south-eastern part of the Russian Federation. It is bordered by Khabarovsk Krai in the north, China in the west, North Korea in the south-west, and is washed by the Japan Sea in the south and east. The largest cities are Vladivostok (601,300), Ussuriysk (172,000), Nakhodka (140,200), Artyom (104,500).
The maximum length of Primorsky Krai (from the mouth of the Tumannaya River to the source of the Samarga River) is about 900 km, the maximum width (from the valley of the Ussuri River to the coast of the Sea of Japan) - about 280 km. The highest peak is Mount Anik (1,933 meters) located in the north-easton of the region, near the border with Khabarovsk krai.
The climate of Primorye is temperate monsoon. Winters are dry and cold with sunny weather; springs are long, cool, with frequent changes of temperature; summers are warm and humid; autumns as a rule are warm and dry.
The main peculiarity - lots of precipitation and fog in summer. Summer is the period of typhoons. The average temperature in July is about plus 17-21 degrees Celsius, in January - minus 8-23 degrees Celsius.
Primorsky Krai - Economy
A number of large and unique deposits of various minerals have been discovered in Primorye. This region has the most powerful mining industry in the Far East of Russia. There are about 100 coal deposits (2.4 billion tons), 30 deposits of tin, 15 deposits of complex ores containing zinc, lead, copper, and silver. Gold deposits are located both in the south of the region and in the north.
The largest in Russia deposit of boron is located near the town of Dalnegorsk. Several phosphorite deposits are discovered on the shelf of the Sea of Japan. There are also several small oil fields, large deposits of germanium. Mountain rivers have significant hydropower potential. Diverse forests cover about 80% of the territory.
Primorsky Krai is the most developed region in the Russian Far East due to its favorable geographic location and abundance of various natural resources. The local economy is based on such industries as mining, timber, fisheries, trade, shipbuilding and repairing.
Primorye has a relatively well-developed transportation network. The main traffic artery is the eastern section of the Trans-Siberian Railway. Due to its proximity to Japan and the Republic of Korea (imports of relatively cheap used cars), Primorsky Krai occupies the first place in Russia in the number of vehicles in the population.
The seaports of Primorsky Krai play an important role in the economy of Russia. The largest container terminals in the Russian Far East are located here. Regional and international air flights are carried out from Vladivostok International Airport.
Attractions of Primorsky Krai
Primorsky Krai is known for its rich flora and fauna, the variety of landscapes, the warm sea in the south, springs with healing water. All this creates favorable conditions for tourism development.
In Primorye, there are more than 500 unique natural sites (lakes, waterfalls, ancient extinct volcanoes, caves, bays). There are six nature reserves and three national parks:
- Far East Marine Reserve in the Gulf of Peter the Great,
- “Kedrovaya Pad” Reserve,
- Lazovsky Reserve,
- Sikhote-Alin Reserve included in the UNESCO World Heritage List,
- Ussuri Nature Reserve,
- Khanka Reserve,
- “The Call of the Tiger”,
- “Udege Legend”,
- “The Land of the Leopard”.
The following places of interest are also noteworthy:
- The Rope Park in Andreevka - a sports-tourist trail that includes elements of sports tourism and mountaineering,
- Shanduyskie lakes - mountain lakes located in the north of Primorye,
- “Black Sand” beach located near the village of Zarubino in Aleut Bay - an interesting beach with volcanic black sand, which is considered to be curative,
- The lighthouse on the southern tip of Gamov Peninsula. Gamov Peninsula is the pearl of Primorye and the Far East.
Primorye krai of Russia photos
Landscapes of primorsky krai.
On the shore of the Sea of Japan in Primorsky Krai
Author: Konstantin Tkachenko
Primorsky Krai scenery
Small river in Primorye
Author: Melnitsky Stanislav
Primorsky Krai views
Forest in Primorsky Krai
Primorye landscape
Village in Primorsky Krai
Author: Roman Mikulchik
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So has the problem of Customs and Border controls been sorted out. The Area has a good future if red tape does not stifle the economics of trade (and survival). Francis
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We are going to Vladivostok in July this year and want to go to do a tour/visit the Tiger Research Centre and some National parks in the area.
Can anyone advise if this can be organised easily once you arrive - or should we continue to try and book it before we get to Vladivostok. We are having a lot of trouble finding any information pr getting responses to e-mails.
You can go online to the website pacific-wave.net and look for information on their tours or contact them directly......they have a Tiger Tour beginning just about the time-frame you are speaking of...other Eco-tours can be arranged also. Good outfit and dependable...I use them whenever I travel to Vlad.
This post has been removed at the author's request.
There is the Tiger Center, but I was not reffering to that but an actual Tour of the territory where the tiger inhabits...in the wild...read the tour outline carefully.
There is the research center...for viewing caged animals...whic is an option.....I would contact them before
my trip if I were you.
Actionaly as I worked at tourist compony 5 years can tell it is not too easy to talk with man who own this too miles with 4 tigers and 3 cutes at my last wisit there + two bares in the cage + fox in the cage + wild cats in different cages and some deers which jump always though the wall when snow of there 200X200 place. The animals there are been ill or hunted before and this piople are safed many animals life. Im very sorry that some making pictures of this place for money and advertisment this man wise. I worked at this company http://www.voyage-service.com/modules.php?name=eco&page=ginseng and made the site. There been there own site I rememmber but there is long trip3houres to Spask with russian road so dont eat before but if you go I recoment to stop at Lotus hotel and go for tigers next day when they feed and get excursion woman there at Spask to go for lotus flauwer to make pictures :) the trip for one person I think will be 100$
This topic has been closed to new posts due to inactivity.
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Primorsky Krai - Overview. Primorsky Krai (informally Primorye) is a federal subject of Russia located in the south-eastern part of the country, in the south of the Far East, part of the Far Eastern Federal District.Vladivostok is the capital city of the region. The population of Primorsky Krai is about 1,863,000 (2022), the area - 164,673 sq. km.
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We are going to Vladivostok in July this year and want to go to do a tour/visit the Tiger Research Centre and some National parks in the area. Can anyone advise if this can be organised easily once you arrive - or should we continue to try and book...