Bryan Johnson— the wealthy tech entrepreneur who is experimenting on himself in an effort to live forever— said this
He is missing nothing. Two decades ago, leading science figures like Collins promised that genomics would affect all aspects of medicine— in sickness and in health.
Sequence your genome to learn what blood pressure pill or heart burn medicine to take— that was the promise.
Yet, Brian is correct that for healthy people (or those with common conditions, e.g. HTN) the answer is: genomic knowledge has little to no practical value.
It isn’t that you are perfect and can’t improve. It’s that we all need to do the same things. Diet, exercise, medication, lose weight, (for Brian, swapping blood from you teenage son, wearing a red light, swallowing a thermometer and going in the sauna)— these all can be recommended to everyone regardless of genome.
Of course with disease it’s different.
In cancer medicine, the genome is use commonly. Mostly we use the Cancer’s genome. Not yours. Only a tiny handful of HLA specific therapies, transplant, use a portion of your genome. Many drugs target the Cancer’s genome— regardless of yours.
The biggest drugs of the last two decades have nothing to do with the genome at all. Their large market share is buoyed by the permissiveness of the label. Pembro makes hundreds of billions precisely because it works so indiscriminately.
Rare and childhood diseases have also benefitted from genomics in diagnosis— though treatments often lag.
For some diseases, we now have bespoke gene editors. For conditions that present with childhood symptoms, genomics is often vital.
Fixing small defects in enzymatic processes is one thing, fixing large structural defects, where the defect proteins pile up in cells over years, and then hoping to undo the damage is quite another.
Ultimately, the idea that the human genome is like the letters in a book that tells you how to build and run a person— that analogy has done a lot of damage. The human genome sequence is like taking a Lego sculpture in a lego exhibit- one with 10 million pieces— putting it under a hydraulic press, and then looking at the patterns of colors, trying to deduce the shape and function of the original object. DNA is a moving, living molecule with 3 dimensional interactions we can scarcely understand.
It is nothing like letters in a book.