Proposal Urges Stronger Focus on Social and Environmental Factors in Precision Medicine

March 08, 2017

When it comes to having good health or getting sick, a person’s genetic code is important. But so is a person’s zip code. These strong influences are all part of precision medicine, which includes analysis of an individual’s genes, environment and lifestyle to inform disease prevention and treatment.

Yet genes tend to be the main focus in research and practice, often leaving out the social and environmental parts of the story. Researchers at Ann & Robert H. Lurie Children’s Hospital of Chicago propose new terminology for social and environmental influences on health, in efforts to balance the predominant emphasis on genes in precision medicine. Their proposal, entitled “The Missing –Omes: Proposing Social and Environmental Nomenclature in Precision Medicine,” was published in Clinical and Translational Science.

“Although where a child lives and goes to school often has more bearing on his or her health than the genetic code, social and environmental factors get far less attention than the genetic influences in precision medicine research,” says lead author Matthew Davis, MD, MAPP, Division Head of Academic General Pediatrics and Primary Care at Lurie Children’s, and Professor of Pediatrics and Medical Social Sciences at Northwestern University Feinberg School of Medicine. “We hope that the broader and more consistent terminology we propose will facilitate more collaboration across scientific disciplines. Whenever we open new lines of communication between fields that rarely talk with one another, the possibility of advancing understanding and improving health grows exponentially.”

The authors suggest a naming system that expands the “-omes” discussed in precision medicine, such as the “genome” or “proteome,” which describe the factors within an individual’s body that impact disease or wellness. They call these internal domains the “endome.” Similarly, they refer to the many influences on health that come from outside the individual as the “ectome.” For example, health-related aspects of a person’s social support network are called the “philome” and diet-related factors fall into the “nutriome,” while health-affecting components of water sources belong in the “hydrome.” 

“By adding the social and environmental ‘-omes’ we hope to expand the precision medicine paradigm and encourage more comprehensive data collection in efforts to understand and prevent disease,” says co-author Thomas Shanley, MD, Chair of the Department of Pediatrics at Lurie Children’s and Northwestern University Feinberg School of Medicine, Chief Research Officer at the Stanley Manne Children’s Research Institute, and the Founders’ Board Centennial Professor. “We need a common language and inclusion of all the known determinants of human health to push the field of precision medicine forward.”

To advance these concepts and develop a repository of rigorous measures for the different “-omes,” the authors have launched a website – “We hope that will serve as an online forum for scientists, spurring conversation and innovative ideas,” says Davis, who is the A Todd Davis, MD, Professor and Director of the Mary Ann & J. Milburn Smith Child Health Research Program. He also serves as Associate Chief Research Officer for Health Services and Policy Research at the Stanley Manne Children’s Research Institute at Lurie Children’s. “We welcome experts in different fields to suggest the most appropriate objective measures for the various social and environmental impacts on health.”

Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through the Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge.

Lurie Children’s is ranked as one of the nation’s top children’s hospitals in U.S.News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Last year, the hospital served more than 198,000 children from 50 states and 51 countries.