To say that the American health-care system is in less-than-great working order may strike many as a colossal understatement. Yes, it functions well on the heroic-medicine front. It possesses incomparable medical technology and pharmaceuticals, and it can boast an impressive corps of well-educated and compassionate physicians, nurses, and other health-care workers. For all those strengths, however, American health care labors under mighty challenges, including an overstretched and underfunded public-health system, the increasing concentration of hospitals and even medical practices in the hands of for-profit businesses, and a patchwork health-insurance regime that leaves too many people inadequately covered and gives too much control to insurance-company executives and too little to health-care professionals.
Related to, and compounding, those and other problems is a consequential and arguably insidious paradigm shift—one that is moving medicine away from the guiding imperatives of patient care and the cure of illness to an overriding concern with the prediction of health risk, an approach dubbed, with no trace of modesty or irony, precision medicine. This shift is evident in the explosion of interest in technologies that not only help people manage diseases they currently have but also make it possible for people to monitor themselves for signs of diseases they might develop in the future.
Consider the case of the continuous glucose monitor (CGM), which for the past twenty years has enabled diabetics to track their blood sugar in real time without the annoyance of a finger stick. In March 2024, the Food and Drug Administration authorized the expanded use of these devices for people who are healthy. Many of the new users are concerned about the risk of acquiring the disease, possibly because of excessive weight or family history of disease. Other users simply consider the monitor to be a tool for self-optimization, the kind of instrument promoted, for example, by the Quantified Self movement. After all, if you monitor your steps, blood pressure, and sleep, why not your blood sugar? If you are at risk for diabetes from episodes of high blood sugar, the monitor will alert you when to avoid foods that elevate it. Though not ill, you take on the habits, routines, and technologies of the sick.
The expanded use of the CGM is just one example of a growing desire among individuals, governments, technology companies, and corporate health-care systems to predict and monitor health risk. The focus on risk can be seen in the popularity of a range of consumer products, including direct-to-consumer genetic testing provided by companies such as 23andMe. It is even more dramatically on display in the efforts of health-care practitioners to use AI-based techniques to combine information from genetic tests, medical charts, demographic studies, surveillance devices, and other data sets to predict the risks facing an individual so that those risks can be assessed, managed, and treated. Such a data-centric methodology is another trait of precision medicine.