Social Systems Matter: Precision Medicine, Public Health, and the Medical Model

Abstract

Drawing on data from semi-structured interviews conducted in Singapore, Canada, and the United States, this paper shows that biomedical experts are deeply concerned about the shortcomings of the biomedical model of health. Precision public health, when anchored in genomics, can be considered a twenty-first century version of the medical model of health, which originated from nineteenth century germ theory. First, concerns regarding the adoption of genetic testing to identify disease susceptibility, and limitations of genome-based disease prevention exist. This includes limited evidence of the utility of screening measures in reducing mortality, lack of reimbursement for genetic screening, negative implications of genetic screening, and limitations of race/ethnicity-based genetic screening. Second, there are also concerns regarding the treatment of diseases, particularly the management of the costs of treatment and genetic testing in the context of national public health systems. Ultimately, it was found that healthcare-related inequities can be reduced in a universal, publicly funded, single-payer healthcare setting. These findings provide strong evidence supporting the social model of health by highlighting the key role of social systems and non-clinical interventions in precision public health to improve health outcomes for all.

Keywords:

• precision medicine
• public health
• medical model
• social model of health
• cancer

Acknowledgements

We would like to thank the research assistants Zoe Ong, Hemavalli Padmanathan, Yan Ru Lek, and Lee Wen Ling Patricia, for their practical contributions to the research project. Our sincere thanks go out to the interviewees who have shared their views with us. Feedback by Lynette Chan, Francis Lim, Jin Yi Chua, and Hallam Stevens have helped sharpen the analysis. We are grateful for the EASTS editor Wen-Hua Kuo and the anonymous reviewers for their expert guidance.

Additional information

Funding

This research is supported by the Ministry of Education—Singapore, under its Academic Research Fund Tier 1 [M4011927.SS0 RG161/17].

Notes on contributors

Shirley Sun

Shirley Sun received her PhD in Sociology from New York University and currently holds appointments in Sociology and the Lee Kong Chian School of Medicine at Nanyang Technological University (NTU), Singapore. Her research areas include medical sociology, sociology of reproduction, and Science, Technology and Society (STS). She is the author of Socio-economics of Personalized Medicine in Asia (2017, London and New York: Routledge), where she draws on extensive interview data with physicians and geneticists in Asia, primarily in cancer care, regarding their understanding and experiences of precision medicine. Dr Sun has been appointed a member of an International Working Group by the Centre for Biomedical Ethics at the Yong Loo Lin School of Medicine, National University of Singapore (NUS) on its Big Data Ethics in Biomedicine project funded by the Singapore National Medical Research Council (2018-2021).

Ann Hui Ching

Ann Hui Ching is a final year medical student at the Yong Loo Lin School of Medicine, National University of Singapore. From 2018-2019, she was a research fellow at Yale Plastic Surgery studying perceptions of femininity and attractiveness in Facial Feminization Surgery. Her research areas include medical sociology, race/ethnicity in medicine and Science, Technology and Society (STS).