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Soon-Shiong was introduced to the crowd at the Petersen Automotive Museum by Arizona State University President Michael Crow, who is also a scientist with a background in innovation and technology transfer. “Meet Batman,” Crow told the audience. Like Bruce Wayne, Soon-Shiong is a polymath and businessman using “mysterious technologies” to wage a war–not on crime but on disease and avoidable early death. Soon-Shiong aims to extend, in a cost-effective manner, our “healthspan”–that is, the healthy and productive years of a person’s life.

What, Crow asked Soon-Shiong, is driving you to take on a monumental problem that even the government can’t seem to tackle?

I’m driven “from the position of physician,” said Soon-Shiong, who is also a surgeon and was a professor at UCLA’s medical school. Over and over again, he has seen patients receive the wrong treatment–and suffer as a result–not because the right treatment didn’t exist but because doctors don’t have the needed cognitive support or enough information to make the right decisions. “I’m driven by opportunity lost not just for the patient or for our country but mankind,” said Soon-Shiong.

There are three barriers, said Soon-Shiong, to getting doctors the information they need: knowledge, delivery, and payment.

The knowledge barrier “is exploding every day,” he said. In the past five years we’ve made more scientific discoveries and breakthroughs, and developed more tools for improving our health, than in the last 50 years in medicine. But this knowledge takes an average of 17 years to get to patients.

The barrier to better healthcare delivery is in transferring information and coordinating care from the clinic to the lab and the hospital to the home; patients aren’t getting the decision support they need and could receive.

Our payment system is the final barrier. Doctors and hospitals are reimbursed not to keep you healthy but to do as much as they can when you’re sick. These “perverse incentives,” said Soon-Shiong, get in the way of patients receiving preventive care.

These problems are massive, but Soon-Shiong decided that they could be integrated into a single solution by attacking them in their most severe manifestation: when a patient is diagnosed with cancer. “If we can address illness and fix the system in a state of emergency, then we can fix it in [a state of] wellness,” he said.

Two million people are diagnosed with cancer each year, but the “scariest statistic,” said Soon-Shiong, is that 32 percent of the patients receive the wrong treatment.

Crow explained that most cancer drugs work for a small number of patients but are administered to a much larger number of patients in the hope that they’ll somehow work.

It doesn’t have to be this way, said Soon-Shiong. We have the ability, with our knowledge of the cancer genome, to find out what caused a person’s cancer at the molecular level and to treat that specifically rather than administering a blanket treatment that has a low statistical probability of success. The cost of this sort of treatment is also decreasing. This year, it will cost $1,000 (less than a CAT scan) for a complete genomic analysis of a blood test, which can identify with great precision what’s going on when you’re ill.

This molecular medicine, coupled with wireless technology, could change how cancer and other diseases are treated and how preventive medicine is administered. Computer and cloud technology has made it possible to monitor our vital signs in real time and to share this information with our doctors wirelessly–as well as to have it analyzed, and to have that analysis sent to patients on their smartphones.

“It sounds crazy, but that’s what we do, and what we’ve done,” said Soon-Shiong. His October announcement will reveal how he’s successfully implemented this technology and how it could improve care across the board, level the healthcare playing field, and be exported from the U.S. into other countries. It’s taken seven or eight years, investment in a host of institutions, and the integration of the work of doctors and computer scientists, nurses and healthcare providers. But Soon-Shiong thinks it may revolutionize U.S. healthcare and the treatment of a host of chronic diseases, from heart disease and diabetes to Alzheimer’s. Soon-Shiong has already introduced the program to 8,000 oncologists, whose rate of treatment error he says has gone from 32 percent to zero in treating cancer patients.

Crow asked Soon-Shiong to address some of the privacy concerns patients might have about their health information being transmitted wirelessly. “You need to recognize that this is your data,” said Soon-Shiong–it’s something that a patient shares with a doctor, not the other way around.

So what, asked Crow, is stopping you from implementing this right away?

Soon-Shiong explained that waste is embedded in our healthcare system: “Some people’s waste, other people’s profit,” he said. “There’s not one penny being spent [by the government] on what I just talked to you about.” The pharmaceutical industry doesn’t see the upside in developing a drug that can treat 100 people. The insurance companies don’t exist to keep patients healthy but as brokerage systems. And in academia, silos are keeping research and clinical practice separate.

In the question-and-answer session, audience members asked Soon-Shiong if the FDA is posing another hurdle, what the medical school and hospital of the future will look like, and if there’s a point in getting genetic information that doctors can’t act on.

Regarding government drug regulation, Soon-Shiong said that he has “a fabulous personal relationship with the FDA.” He had 70 drugs approved in 10 years when he began developing drugs. The FDA’s Critical Path Initiative is also working to speed up the process of developing drugs and adjusting to the speed of the new world of molecular medicine. “I’m hopeful,” he said, about the future of the drug test and trial process.

“If I have a complete genome analysis and find out that in the future I will have breast cancer, what do I do with that information?” asked an audience member.

Soon-Shiong said he shared this skepticism a decade ago when the genome was discovered, thinking that predictions and probabilities would cause more stress than they were worth. But today, genomic medicine has evolved to the point where an abnormality or illness can be identified and treated as it’s occurring. “If you’re going to do a test for something for which I can do nothing, don’t do the test,” he said. “But if you can do a test that can change the direction of a treatment, you should do the test.” The concept of the genome is really for treatment of illness, he concluded.

Another audience member asked Soon-Shiong what he thinks medical schools and hospitals will look like in the future. Soon-Shiong predicted more integration in medical schools among not just physicians and nurses but other fields like economists. He thinks we’ll also see a reversion back to a form of medicine that’s more like the home care he received growing up in South Africa–the doctor coming to the door with a black bag. The doctor will become more like a priest, with a great deal of personalized information about patients–but patients, too, will have access to the same deep level of information.

Watch full video here.
See more photos here.
Read medical professionals’ opinions on how our routine physicals will change in the next decade here.
Read about the challenges facing L.A.’s biomedical industry and its potential here.

*Photos by Aaron Salcido.

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Los Angeles has a similar problem–the Tyson Gay problem–when it comes to biomedicine. Certainly, the region turns in a performance that’s impressive in many ways. A 2011 study by Jones Lang LaSalle concluded that Los Angeles–thanks to its many hospitals, research universities, and college-educated inhabitants–has the makings of a world-class biotechnology sector. However, when it comes to rankings, Boston, New York, and the Bay Area claim the gold, silver, and bronze, respectively, while Los Angeles comes–you guessed it–fourth.

What makes a regional winner? It begins with novel research and innovation at local research institutions. This innovation gives rise to promising startups that form a cluster. That cluster is in turn nourished by a self-reinforcing local ecosystem of informed investors, skilled businesspeople, technical resources, government agencies, and economic development efforts. It’s an ecosystem that nourishes high-growth companies that lay down roots and mold a pool of experienced entrepreneurs, who likewise lay down roots and go on to create the next generation of startups–based on breakthrough ideas from the local research institutions. It’s a tough cycle to get going, but it’s great when it works!

L.A. has the beginnings of biomedical victory in place already. The region boasts one of the strongest concentrations of research power in the world. The California Institute of Technology, the University of Southern California, and University of California, Los Angeles alone account for more than $2 billion in annual research funding and collectively boast 38 Nobel Laureates, 66 National Medal of Science recipients, and 126 members of the National Academy of Sciences. The Los Angeles County Economic Development Corporation reports that approximately 38,000 people in L.A. County work in the life sciences sector, as do 40,000 people in neighboring Orange County, according to BIOCOM estimates. The region is home to many wealthy investors, angel networks, and venture capital firms. It has the largest manufacturing base in the U.S., a major network of hospitals, and an emerging biotech economic development corridor supported by local government.

Los Angeles research institutions are already generating many viable startups. Over the past 15 years, for example, 39 startups based on research conducted at USC raised more than $800 million in investment capital, and more than $380 million of that was raised in the past three years, at the height of the financial crisis. In 2009 alone, Caltech’s research launched an impressive 18 new companies. As for UCLA, Abraxis BioScience, acquired by Celgene for $2.9 billion, is a formidable success story.

That’s the good news. The bad news is that many of the companies that start here don’t stay here. In most places in the United States fewer than 10 percent of startups leave the region where they were incubated, according to a report by the Battelle Technology Partnership Practice. In the Los Angeles region, 50 percent leave, and that number may be growing.

Why don’t companies in Los Angeles want to stick around? I got some insight into this several years ago, when I was helping biomedical companies to develop their strategies and find the resources to execute them. One client, a cancer therapy company, relocated to San Antonio, Texas, because the cost of living was lower and there was a better defined network of resources and investors. Another client, a stem cell therapy company, could not find adequate lab space in Los Angeles. It moved to San Diego.

Later, I worked at USC to help develop an innovation ecosystem to encourage the launching of startups–and I often coordinated my efforts with UCLA, Caltech, and other institutions in the area. We made the following observations:

First, when we had scientific researchers with breakthrough discoveries, we had trouble consistently finding experienced Los Angeles-based biomedical entrepreneurs to help advise on the best way to commercialize the technologies. You need experienced entrepreneurs–the “been there, done that” folks with deep domain expertise–to help identify what markets a new, early-stage technology best addresses and what specific development steps will position it for success. Ideally, these entrepreneurial advisors also fall in love with the technology and help create and lead a startup based on it.

Second, even if we were lucky enough to connect the inventors and their technology to an experienced mentor, any startup formed around the technology would often struggle to find nearby “incubators”–entities that provide wet lab space and other technical and business resources. In Boston and San Francisco, biomedical incubators are plentiful.

Third, we found that many local private investors were poorly informed on local emerging technology opportunities, and few local venture capital firms were willing to invest in early-stage biomedical start-ups.

Finally, as anyone who has tried to get from Pasadena to the Westside at the wrong time can attest, Los Angeles is geographically dispersed. Life-science entrepreneurs and other folks in the innovation ecosystem lack a central physical location to mingle and have the valuable chance encounters that lead to the sharing of ideas and resources.

While the above litany of issues might sound intimidating, most can be addressed without as much trouble as we fear.

Let’s turn back to the Olympics for inspiration. Sixteen years ago, at the Atlanta Olympics, Great Britain won only a single gold medal. This year, it won 29. What happened? After 1996, each sport’s governing organization appointed a “performance director,” a person responsible for setting goals, identifying promising athletes, tracking progress, and locating and coordinating the best coaching and other resources. It was simple, but it worked. The difference between fourth and first isn’t necessarily so big. It simply involves looking at the whole system, using what you have as effectively as possible, and doing a lot of small things slightly better than you were before. Then success breeds success.

Los Angeles could benefit from having something similar: a “Biomedical Sector Performance Director” to accelerate the development of the greater Los Angeles life sciences ecosystem. Coordination, communication, and timely connections will help startups emerging from our leading research institutions avoid having to reinvent the wheel as they look for resources to grow. They can be connected quickly to local incubators, experienced local entrepreneurs, investors, and other local startup business resources. Just cataloguing local resources and making them available to emerging startups would be a simple improvement with huge effects. It’s an example of the power of a small thing done better than before. A coordinator could help align local governments and other partners in the ecosystem, identifying gaps and encouraging approaches to address them.

Who would appoint such a performance director? Our “sport” of Los Angeles biomedicine does not have a governing organization, but it does have within each major research institution well respected technology transfer organizations dedicated to identifying research with commercial potential and devising strategies for how to exploit it. I would suggest having the performance director report to a board comprised of the heads of these tech transfer organizations. This would have the added benefit of positioning the performance director to cross-pollinate ideas emerging from the various research institutions as well as connect them to resources when they are ready to emerge. A second small thing done better than before.

Some might ask, “Do the rankings matter? Isn’t fourth place still pretty good?” Well, it’s pretty good, but it’s nowhere near as useful as third place. Being higher on the list would make Los Angeles a far more powerful magnet to attract investors, experienced biotech entrepreneurs, and other elements of a self-reinforcing life science ecosystem. Setting goals, measuring progress, and then bragging about it in the right way to the right people is essential–a third small thing that we can do better. By the way, Tyson Gay is also an American record holder in speed, the second-fastest athlete ever, and one of only three sprinters who have defeated Usain Bolt in the 100 meter distance. But who’s going to get the best endorsement deals?

Richard Hull is an entrepreneur and investor. He lived and worked in Los Angeles for 15 years before recently moving to Olympia, Washington.

*Photo courtesy of Miss Krin.

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Going to the doctor and getting your chest bumped and your arm squeezed might feel reassuring, but the physical, like primary care physicians, is on the wane. The good news is that we’re likely to be a lot better at testing, monitoring, and interpreting the data we get. Gizmos will change the game. In advance of the Zócalo event “How Can Biomedicine Fulfill Its Promise?” three medical professionals offer a forecast of what to expect from the physical of tomorrow.

Say goodbye to the routine physical

What will change most about our routine physicals over the next decade is that they will not exist. The truth is, routine physical exams are largely useless. Even the AMA states that the primary value of the physical is to maintain a personal connection to your physician–not to discover health problems early. If we can get our political and social act together, we have the technological capability to revolutionize how we monitor our health. Biometric information (temperature, blood pressure, etc.) will be monitored wirelessly on each individual for retrieval and analysis. People are already starting to do this.

What will change things most is that we will have the means to routinely and comprehensively screen ourselves for any disturbance in health. A patient will regularly mail in a drop of blood or saliva for analysis. Within days, a central lab will post the results to the patient’s personal web site, and screening will allow for the detection of the earliest stages of almost any disease. The data will be yours to share and analyze as you wish.

Eventually, instruments for reading your blood or saliva samples will be in your home. It will essentially be real-time monitoring. The data will be yours to control. The word “patient” will have passed from the lexicon.

Dr. Stephen Johnston co-directs with Dr. Neal Woodbury at the Center for Innovations in Medicine (CIM) at the Biodesign Institute at Arizona State University.

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We’ll get our care online–but fancy technology comes with new costs

The healthcare systems of most developed countries are organized to provide all the care you need, whether or not you can afford it. America’s healthcare system is aligned to provide all the healthcare you can afford, whether or not you need it. As a result, Americans pay more for their healthcare than anyone else on earth. No other country comes close.

Americans can be justifiably proud of their prowess in biomedical research, but this knowledge has to be applied carefully. Otherwise, the “promise” of biomedicine could prove to be a curse. Rather than getting a routine physical in 10 years, much of our preventive care will be accomplished online. Will preventive care in the future also include an analysis of each person’s genetic code? I hope not.

We hear a lot about the benefits of genomics but very little about its risks. These include: false-positive test results that trigger needless worry and costly diagnostic workups; the detection of a gene that might (but probably won’t) cause problems later in life; labeling otherwise healthy people “high risk,” potentially rendering them uninsurable and possibly unemployable, and the prospect of consigning hundreds of thousands–perhaps millions–to an interminable series of doctor visits, follow-up tests, and treatments to prevent disease in a few.

In a nation long fearful of healthcare rationing, we are just beginning to come to grips with the opposite problem–the enormous costs and grievous harm that come from excessive testing and needless treatments. Don’t forget–an American’s odds of living a long and healthy life still depend more on his zip code than his genetic code. That won’t change until we make healthcare more affordable.

Dr. Arthur Kellermann, an emergency physician, holds the Paul-O’Neill-Alcoa Chair in Policy Analysis at the nonprofit, nonpartisan RAND Corporation.

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We’ll have Onstar for the body

In the future, medical exams will be personalized and tailored to the individual, to a person’s specific genetic profile. Some exams will be annual, some monthly. Some will be augmented by telemedicine or other forms of contact between the patient and clinical care team, but in-office visits will be far fewer.

Medical devices will allow for steady, rather than occasional, monitoring. Instead of a doctor performing a random spot check once a year, a widening array of mobile devices, including wearable sensors, will monitor blood pressure, blood sugar and other health-related metrics on a steady basis. Among the devices to expect: mobile-phone-connected blood-pressure cuffs, wearable pedometers to track exercise regimens, sleep monitors, even home-based “medical tricorders,” for which an X-prize was recently launched.

Artificial Intelligence (AI), or, as I prefer to call it, IA (Intelligence Augmentation) will play an important role in interpreting the data, helping to correlate signs and symptoms. It will also offer clinical guidelines and other information to augment the skills and decision-making of the clinician, who in many cases will be a nurse practitioner.

To prevent an overflow of information from multiple sources, data will need to be integrated into dashboards to lead to meaningful and actionable information. I envision integrated systems similar to those of modern cars, which have hundreds of sensors and an onboard diagnostic computer which can help detect problems early and indicate to the driver what is going on. All of us will have Onstar for the body.

Daniel Kraft, MD, is executive director of FutureMed.

*Photo courtesy of Shutterstock.

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Medical technology and record keeping have gotten good. A little too good. Your health secrets are shuttering about in cyberspace, vulnerable to interception by hackers. Your DNA can tell you if you’ll get Huntington’s Disease. And a lot of us are starting to think we know as much as our doctor. The digitization of medicine brings all sorts of ethically thorny challenges. Which are the biggest? In advance of the Zócalo event “What Will Digital Medicine Look Like?,” several medical professionals offer some answers.

The biggest ethical challenge will be to bring about a balance of power

Digital medicine is turning out to be a multi-million-dollar business, and many companies have jumped into the field. Certainly, digital medicine is a welcome development, but making optimal use of technology is more important than making blind use of technology. With the evolution of concepts like Health 2.0, patients are getting involved in decisions that affect their very survival instead of blindly following orders from experts.

I believe the biggest ethical challenge before us in medicine is using technology to create a balance of power among the stakeholders–and that includes patients. (Believe it or not, patients are important too!)

It would be easy to fall into the trap of using technology to create more expensive systems centered even more on large healthcare and health IT organizations. Many ehealth solutions already leave out patients and caregivers in decision-making. Instead, technology should be used to break the stranglehold healthcare professionals have on healthcare. Digital medicine can and should be used to promote participatory medicine.

Dr. Neelesh Bhandari is author of Digital Medicine, CEO of Digital MedCom Solutions, and chief mentor at RAKSHA (Society for Knowledge and Health).

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The biggest ethical challenge will be to ensure adequate privacy

In the past, medical information, even your personal information, was a closely held secret. Your health provider was in an extremely powerful position, possessing exhaustive knowledge about medicine in general and about you in particular. As an individual, you had far too little understanding about the secrets of the trade and far too little information about your own health data.

The person who has knowledge wields enormous power–and can therefore do enormous damage if that power is used inappropriately. The information age has enhanced this dynamic, with an explosion of mechanisms to access health information in ways never before conceived.

We can now access an unlimited amount of personal information about our conditions, conditions we think we have, and, potentially, the health status of others. This is an enormous opportunity to improve the health of people and communities, and the benefits clearly outweigh the risks, but the challenge is how to make sure this access to information is used in an ethical way.

People who work in healthcare today therefore have several responsibilities to society: (1) To preserve the privacy of the information they collect, exchange, and share. (2) To ensure the accuracy of that information. (3) To find ways to mitigate the effects of false negative and false positive results. (4) To imbue the consumer with the health literacy skills to understand the material that is available.

Georges C. Benjamin, M.D. is executive director of the American Public Health Association.

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The biggest ethical challenge will be to enhance privacy and understanding

The digitization of medicine promises high-speed, open-access, personalized healthcare, but it comes with two particularly big challenges. They are understanding and privacy. Many of us think we know more than we do, and as medical information becomes ever more accessible, patients may feel unduly confident about their own medical decisions, and physicians may feel pressure to make use of information outside their area of expertise. This could lead to serious errors in care. As far as privacy is concerned, the increased use of social media has made us less rigid about our privacy. However, as we move towards genomic testing and the potential to learn about future disease risks, privacy takes on another dimension: the right not to know. Data access must be carefully controlled so that it is neither misused nor inadvertently provided. If you’re at high risk for Alzheimer’s disease, you don’t want to discover it through automatic ads for memory enhancers that come up whenever you’re using your favorite search engine.

Erynn Gordon, MS, CGC. is director of Genetic Counseling at the Coriell Institute for Medical Research, Camden, NJ.

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The biggest ethical challenge will be to fend off hackers and snoops

The digitizing of medical records has many benefits, but the biggest ethical hazard is the potential for inappropriate access to medical information. Confidentiality is one of the oldest principles of medical ethics. Perhaps paper records can’t be encrypted the way electronic records can, but paper usually provides greater privacy protections, because it is so difficult to search through. If you were looking through the records of hundreds of people to find some term of interest, e.g., “sexually transmissible disease,” you’d have to pore through hundreds or even thousands of pages of paper. But with electronic records you can simply type in the phrase, using a keyword search.

Certainly, records require passwords, but we all know that password protection is not foolproof. Hackers often find their way into databases, and, as we have seen, human error can cause unintended failure in even the best-designed system. Public trust in digital medical information could be gravely compromised by a few high-profile failures, and such failures are inevitable. Then again, we face much the same consequences in much of the rest of our computer-based life, from credit card breaches to cyberattacks on national defense operations. But medical privacy is a sacred trust, and therein lies the difference.

Jonathan D. Moreno is author of The Body Politic: The Battle Over Science in America.

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The biggest ethical challenge will be to deal with discrimination, confusion, and apprehension

As medicine becomes more electronic and “digitalized”–as people’s entire genomes are sequenced and stored in biobanks–several major ethical challenges and dilemmas arise.

First, concerns emerge about possible discrimination. Currently, life insurance, disability insurance, and long-term care insurance can all legally request copies of an individual’s complete medical records and use the information to determine whether to cover the person or not. A person may be healthy, without any symptoms, but have a genetic mutation associated with a serious condition, and thus be denied insurance.

While the Genetic Information Non-discrimination Act (or GINA) is designed to prevent health insurance discrimination, no such federal laws exist to prevent discrimination in applying for these other important kinds of insurance. Such laws are needed.

Moreover, even with GINA, subtle discrimination occurs. As I describe in my book, Am I My Genes?: Confronting Fate and Family Secrets in the Age of Genetic Testing, people who had thought that they would be promoted, but who had then mentioned that they had a mutation to a co-worker, have been “passed over” for promotion. They kept their job, but were not advanced, and were sometimes marginalized. After all, no single law has eliminated racism, or gender bias. Discrimination becomes more possible when whole genomes have been sequenced, and can be communicated with the click of a button.

Ethical questions also surface about who would have access to all of the health information generated and what they can do with it. Medical centers and drug companies are collecting many people’s complete genomic information and other health data, including responses to various medications. Do these centers and companies then have a right to patent their discoveries and earn millions of dollars as a result–at the expense of patients? Myriad Genetics patented the two mutations found to be associated with breast cancer; now it charges around $4,000 for the test. The test itself costs only a small fraction of that–the rest is profit. Health insurance companies do not all cover the full costs. Millions of women also lack health insurance.

Individuals may have their full genome sequenced, but if genes are patented, the costs of each individual test could run into thousands of dollars. Many critics argue that genes–as products of nature, shared by humanity–should not be patented, while proponents claim that scientists may be patenting only the method of isolating the gene. But companies holding these patents can then charge anyone who wants to test for the gene. Critics argue that to then “own” the rights to the gene violates basic moral principles. Moreover, the U.S. government has spent billions of dollars to conduct the basic research on the genome that has allowed for the isolation and understanding of these genes in the first place.

Major concerns also arise because patients and physicians do not understand all aspects of genetics and health information. Most information that whole genome sequencing now provides is extremely ambiguous and will not provide ready answers about how we should prevent or treat disease.

Evidence suggests that most common diseases–diabetes, depression, heart problems–result from complex mixes of genetics, other biological and environmental factors, and behavior. Yet genetic markers may suggest that an individual has a 20-percent chance of developing Alzheimer’s or a 20-percent chance of having a child with autism. It is unclear what doctors or patients should do with this information.

The individuals I interviewed for Am I My Genes? were often confused by the complex genetic information they received. Some women who learned that they had a breast cancer mutation but had no symptoms decided to undergo prophylactic surgery–having their breasts and ovaries removed so that they would never develop cancer. Others were unsure what to do. These questions are difficult and troubling, and the more genetic information we receive, the more we will face countless dilemmas without ready answers. Though some scientists argue that “personalized medicine” will be developed, thus far, the vast majority of genes discovered have not led to new prevention strategies or treatment.

In many ways, we are simply collecting more data than we can interpret–we don’t know what it all means. Much of it may be helpful someday, but that may be decades from now. In the meantime, much of the information may result in discrimination, confusion, and apprehension. That’s why we must improve the general understanding of genetics, science, and health and ensure that optimal legal protections exist. That alone will take a lot of work.

Robert Klitzman is director of the Masters of Bioethics Program at Columbia University, and the author of Am I My Genes?: Confronting Fate and Family Secrets in the Age of Genetic Testing, and other books.

*Photo courtesy of flickingerbrad.

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