Does proteomics need a “big government” approach?  pg. 2

A big government approach isn’t universally embraced. Some scientists worry that serendipity – the chance discovery that dramatically shifts thinking about a biological problem – would be squelched by a bureaucracy which determines the research agenda in advance.

Other researchers believe that the diversity and complexity of the protein world simply doesn’t lend itself to a “Human Proteome Project.”

“There is no human proteome as far as I’m concerned,” says Emanuel Petricoin, Ph.D., co-director of a clinical proteomics program operated jointly by the U.S. Food and Drug Administration and the National Cancer Institute.

“The proteome is constantly changing and fluctuating in the context of the person, what that person is exposed to, the time of the day, the underlying disease process, so I don’t think we’re going to decipher a human proteome set,” Petricoin says.

“I think what we’re going to try to understand is the proteins that are changing as a consequence of the disease. We’re going to use those proteins as therapeutics, biomarkers and tools to basically drive the clinical decision. That’s where the money is in the pharmaceutical industry.”

While proteomics may lead to significant improvements in the diagnosis and treatment of disease, those applications will be expensive, at least initially, and health care consumers will be required to pay an increasing proportion of the cost, predicts ethicist Daniel Callahan, Ph.D., director of international programs for the Hastings Center in Garrison, N.Y.

The rich will be able to afford the higher price tag, but the poor will not. “A two-tier health care system is the inevitable result, and one where the gap between the tiers gradually increases,” Callahan writes in the June 17, 2002 issue of the Journal of Molecular Biology.

Callahan urges a different approach, one that places more emphasis on the socioeconomic determinants of health and disease prevention. “The principal test for biomedical progress would be its impact on population health rather than individual health,” he writes. “It would not aspire to conquer each and every disease, but only those that shortened life or harmed its quality to some significant degree.”

After all, he argues, “the main determinants of population health are not research progress and improved health care (except perhaps for the elderly). They are instead the socioeconomic conditions under which people live.”

In the United States, fully 50 percent of all deaths can be ultimately traced to behavioral causes, such as smoking, obesity and lack of exercise. “The best predictor of a healthy life,” Callahan concludes, “is education, followed closely by economic security.”

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