The state of science and medicine in the State of the Union
As David Malakoff observed at ScienceInsider, science is never the centerpiece of the President’s annual State of the Union speech. On Tuesday evening, however, science and medicine were sprinkled all through it. At SciAm’s Observations, Dina Fine Maron described in detail the speech’s science-related moments. President Obama strongly defended his climate change policies, and he announced something called the Precision Medicine Initiative.
What is “precision medicine”?
I was mystified about what, precisely, he meant by precision medicine. It wasn’t clear to others either. Maybe he was talking about what is usually called personalized medicine, with diagnosis and treatment based on a patient’s genetic makeup?
That’s what Lenny Bernstein assumed at the Washington Post’s To Your Health. He said it means analyzing the DNA in tumors to figure out what particular drug might work best, or–an example Obama mentioned–using a very specialized drug to treat a tiny genetic subset of people with cystic fibrosis. (Obama didn’t mention just how tiny that subset is: about 4% of CF cases, at most about 1200 patients in the US.)
Personalized medicine is what Julia Belluz assumed at Vox, too. She noted that achieving personalized medicine is much harder than it sounds. That’s an odd way to put it, since scientists know all too well that realizing this medical perfection has been, and will continue to be, very hard indeed.
She’s certainly right that it’s been one of the unmet promises of health care for ages. Jeremy Gruber pointed out at Genetic Watchdog that Bill Clinton said something similar in his 1998 SOTU speech. To be fair, though, Clinton’s aim was funding increases for the National Institutes of Health and the National Science Foundation. He said nothing about personalized medicine.
Under the confident headline “How Obama’s Precision Medicine Initiative Will Revolutionize Healthcare,” io9′s George Dvorsky declared that precision medicine was much more than personalized medicine, which he defined as therapy for a single individual. He said precision medicine uses biological factors to target therapies at specific subgroups. This strikes me as hair-splitting over small semantic differences, since therapies aimed at subgroups are really aimed at individuals in those subgroups. But never mind.
It does appear that Obama’s use of “precision” rather than “personalized” signals a decision by somebody somewhere that “precision medicine” is now the official label. It also appears that I am behind the times. The National Library of Medicine tells me that the term “precision medicine” was first used in 2009 and picked up speed in 2012. Since then more than 250 papers have employed the term in the title or abstract. However, as long as I’m doing medical etymology here, please note that “personalized medicine” first surfaced in a paper title in 1971 and has appeared in a title or abstract more than 4300 times since then. But never mind that, either.
There are challenges for precision medicine, Dvorsky acknowledged: funding, acquiring and analyzing enough data to define subpopulations, and ensuring the confidentiality of sensitive information. “Given the tremendous benefits to be had, it’s a safe bet that we’ll overcome many of these hurdles,” Dvorsky says cheerfully, optimistic as they always are at io9.
From his lips to the Goddess’s ear. But I would be deceiving you if I didn’t add that achieving personalized/precision medicine has been a slow slog so far. A recent piece of mine on how hard it is to identify disease genes in individuals will give you an idea of just how high those hurdles are. It’s good that Obama is fully on board, but there’s no reason to believe his SOTU nod will speed our long-promised approach to this promised land significantly.
Space, another final frontier
Obama also nodded to our plodding attempts to get into space, with a mention of the recent launch of the Orion capsule, which eventually is supposed to carry astronauts to an asteroid and then to Mars. He also cheered astronaut Scott Kelly, who in a couple of months will try living on the Space Station for a year. Be sure to Instagram it, the President told Kelly, who was seated in a place of honor near Michelle Obama.
Clara Moskowitz, writing at Observations, said the bipartisan applause indicated bipartisan support for NASA even in this determinedly partisan Congress, a cause also high on the Obama agenda. The selection of Kelly, she said, will permit metabolic comparisons with his identical twin, the former astronaut Mark Kelly, who will remain Earthbound.
The state of climate change
The President declared that “no challenge—no challenge—poses a greater threat to future generations than climate change.” But more widely noted was his heavy kidding of politicians’ “I’m-not-a-scientist” meme of the moment, reflexively and routinely produced for evading rational discussion of climate change.
Some well-known climate bloggers had bones to pick, however. ClimateProgress’s Joe Romm complained that, while Obama bragged about his administration’s record on climate and energy issues, he also bragged about our resurgent oil and gas production. It’s quite right, of course, that boasting simultaneously that the US is doing a lot to mitigate climate change while also boosting production of domestic oil and gas is a fine example of cognitive dissonance. But can you expect a politician not to grab for the credit when gas costs under $2 a gallon? Can you really expect him to tell the truth, which is that what would be good for the climate, if not the climate of opinion, would be very expensive gas, heavily taxed?
Climate scientist Judith Curry, always an outlier at her blog Climate Etc., quoted from several grievances expressed by others, and and added her own list. For example, she said, the claim that humans are causing extreme weather events is not supported by the Intergovernmental Panel on Climate Change. And when the Pentagon warns about climate’s threats to national security, it is confusing weather events with climate change. And the idea that 97% of climate scientists agree that people are causing the climate to change is based on “an erroneous and discredited paper,” which she has critiqued a number of times.
The Curry conclusion: “The apparent ‘contract’ between Obama and his administrators to play politics with climate science seems to be a recipe for anti science and premature policies with negative economic consequences that have little to no impact on the climate.”