Beyond Genes and Molecules — A Precision Delivery Initiative for Precision Medicine

Ravi B. Parikh, M.D., M.P.P., J. Sanford Schwartz, M.D., and Amol S. Navathe, M.D., Ph.D.
N Engl J Med 2017; 376:1609-1612

In 2015, President Barack Obama launched the Precision Medicine Initiative (PMI), aimed at enabling “a new era of medicine through research, technology, and policies that empower patients, researchers, and providers to work together toward development of individualized care.”1 He requested $215 million for the initiative in his 2016 budget — public research funding dedicated to creating diagnostics and treatments tailored to individual patients’ biologic (genetic and molecular) profiles.

All physicians aspire to individualize medical care, yet patients often receive care that’s not aligned with their preferences and generally have inadequate access to their health information. The PMI’s scientific advances may add further complexity to delivering high-quality, cost-effective care in keeping with patients’ values. If we don’t grapple with that complexity, patients may wait years to reap the diagnostic and therapeutic benefits of the PMI. A complementary effort in the science of care delivery can promote patient-centered care today by investigating and implementing delivery-system interventions that are tailored to individual needs and wishes, in addition to biology.