The Missing ‐Omes: Proposing Social and Environmental Nomenclature in Precision Medicine

In principle, precision medicine incorporates disease prevention and treatment that takes into account individual differences in people’s genes, environments, and lifestyles. In practice, research regarding genes attracts more attention and resources than research focused on environments and lifestyles. Such progress-hindering asymmetry may be related to dissimilar naming conventions across scientific domains. We propose a novel “-ome”-based nomenclature that incorporates known social and environmental determinants of human health, and thereby reflects evidence across the full spectrum of scientific endeavors in precision medicine. When President Obama announced the Precision Medicine Initiative in 2015, he championed the acceleration of an approach “to disease prevention and treatment that takes into account individual differences in people’s genes, environments, and lifestyles.”1 The National Institutes of Health (NIH) moved quickly to develop plans for enrollment of a national cohort of more than 1 million individuals2 and announced its ambitious infrastructure plans including four geographically dispersed enrollment centers in July 2016.3 The excitement about precision medicine among scientists, clinicians, and the private clinical technology sector contrasts with recent criticism that more than 15 years of burgeoning precision medicine research has not had a measurable effect on population morbidity or mortality, and has drawn research support away from other matters of public health importance.4,5 While precision medicine may take a generation or longer to achieve a population-level return on investment, it is certainly a valid critique that current precision medicine approaches have far more to do with genomes than with environments and lifestyles. Even though methylation patterns in epigenetics are known to be linked to environmental and lifestyle factors in some cases, the scientific emphasis and public excitement remains principally on the genome rather than the causes. If this limited focus persists, it will undoubtedly impair the ability of precision medicine to fully optimize personal and population health outcomes.