| | FEBRUARY 20209ONCE SUCCESSFULLY VALIDATED ACROSS DIFFERENT POPULATIONS, POLYGENIC SCORES WILL ENABLE CLINICIANS TO PICK-OUT INDIVIDUALS WHO FLY UNDER THE RISK RADAR FOR SPECIFIC DISEASES/DISORDERStests in India are imported from other countries. But even though we know that the ability to detect minuscule amounts of circulating DNA from pathological sources is poised to have a clinically meaningful im-pact, there remain a few practical as well as ethical questions to be answered. Can a genetic test really predict your health outcomes? Do you want to know today whether you are at high risk of a disease whose onset may be three decades from now? If the genetic test comes-out positive for a terminal disease that has no cure, what would you do? In a country where `out of pock-et' expenditure is a major part of your healthcare spends, is getting a genetic test done a luxury or a ne-cessity? And if it is a necessity, is the government willing to play a role in making these life-saving tests affordable and accessible? As we address these tough questions, we need to also understand that in In-dia, there are multiple patient bar-riers when it comes to preventive checks that are beyond affordability, and predictive genomic tests being a higher order of preventive care will take some time before having a meaningful impact. Even though the year 2019 wit-nessed significant developments in the preventive space, there is an urgent need for the government to accelerate further reforms and sup-portive measures in 2020 to make India a global genetic test device manufacturing hub, reduce import dependency in this segment, and make personalized genomic treat-ment affordable and accessible to the masses at large.Under personalized genomic medicine, the aim is to individual-ize treatment and empower patients to take more responsibility for their own health. At the core of this concept is the understanding that we are all different, with different biological make-ups and environ-ments. Therefore, a one-size-fits-all approach to diagnostics and treat-ment will soon become out-of-date.Researchers on the other hand are seriously working towards building something meaningful that all doctors will want to recom-mend and all of the population will want to experience. The most recent cutting-edge approach in the hunt for actual genetic contributors to common diseases is polygenic risk scores. Still, there's a long way to go. Experts feel polygenic scores could be the next great stride in genomic medicine. Once successfully vali-dated across different populations, polygenic scores will enable clini-cians to pick-out individuals who fly under the risk radar for specific diseases/disorders. However, like the probability of rain in tomorrow's weather fore-cast, polygenic scores have inherent uncertainty. Appreciating this un-certainty is the key because the un-certainty in polygenic scores leaves room for action. We know that for many complex diseases behavior is just as important as genes in setting the stage for what is to come. Since disease onset isn't solely determined by genes, lifestyle or therapeutic in-terventions can prevent or modify the trajectory of disease.This brings us to the under-standing that genes never work in isolation. Instead, they determine how we react to our diet, social sur-roundings, physical environment, infections, chemical exposures and medicines. Furthermore, in most diseases, factors such as environ-ment, diet and lifestyle work in combination with genetics. Under-standing how these factors affect your health will empower people to make the changes in their lifestyle that will matter most ­ understand what food to eat, which chemicals to avoid, and what exercise regimen to follow. All the pieces to solve this puzzle must come together, and when that happens, genetic medicine is going to become much more precise and, ultimately, far more personalized. Arindam Haldar
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