Appropriate informed consent is indeed an important issue. But except for stating that this needs to be solved, few clues are given on how this could be tackled and what elements should be included in such consent form. Regarding the need for motivating a change in behaviour of the patients, a correct precondition to have an impact on public health, one should also find ways of improving

therapy adherence (compliance) responsible for the numerous failures of medical treatment and preventive measures which could undermine the potential positive effects of PHG. The whole population should indeed benefit from PHG strategies. A major obstacle to this laudable aim will be whether an appropriate health care system (infrastructure, expertise and health insurance) exists. We should not underestimate Selleck SHP099 this and jump directly to the implementation of genomics. Not only low and middle income countries might have difficulties with this. The situation of the health care system in the USA, illustrates that even rich countries might have problems introducing PHG strategies in a just and social way. In view of the potential importance of PHG, some additional considerations are formulated—philosophical, technological or even practical—which were not or only briefly discussed in the report, but Ro-3306 order might need to be considered in future meetings. A series of fundamental questions need to be answered, such as: what is the ultimate aim of these

PHG strategies. Of course we all want help in curing or controlling all major diseases, but how far do we want to go in this? Do we focus only on serious diseases or on treatable or preventable diseases? Will a threshold be decided for the risk to develop diseases at which prevention will be required or even becomes compulsory? Will intensive application of PHG Flavopiridol (Alvocidib) strategies lead to excessive medicalization/geneticalization of the population? Public health is different from well-being. Could a conflict in time

develop between these two important aspects of life and of society? Can a medical approach alone guarantee well-being in a society? How can we find this equilibrium between improving health and maintaining or increase well-being by doing so? PHG is of course aimed at improving public health. The risk nevertheless exists, as our knowledge increases about what makes us sick, that we also learn more about how our normal characteristics are determined. The boundary between health and disease may start fading as a result. Genetic and environmental causes of the variations in normal characteristics might receive much more attention and ultimately people might become more interested in how to influence/select ‘normal’ traits. The money spent on plastic surgery in western countries gives a good indication that the public confuses—rightly or wrongly—health with well-being. The risk to develop a particular disease later in life might indeed not be the greatest concern of our populations.