However, we deliberately chose a cautious tone to our article due to the proliferation of other articles propounding transformative changes in medicine since the sequencing of the human genome more than a decade ago. Although very promising, many questions regarding precision medicine remain unanswered.3 We believe imparting a more realistic vision may serve our profession better from a strategic point of view. Although we are optimistic, we are cognizant of the fact that even the early drug candidates for precision medicine, such as dosing of Warfarin based on genotyping versus traditional dosing, is not well supported.4 While whole genome sequencing would undoubtedly provide a wealth of information about the patient that can be of benefit in selecting the best therapy while avoiding potential adverse drug reactions, promotion of routine whole genome sequencing in our patients as suggested by Dr Gordon1 may not be advantageous for the patient yet. In fact, it may even lead to discovery of incidental findings, which we lack sufficient knowledge to address properly. Genomic information should be treated as any other type of medical information or test: Only ordered if we know the proper action to be taken. Furthermore, issues of discrimination based on patient’s genotype and issues of privacy, among others, should be solved at a societal level before routine whole genome sequencing of our patients is undertaken. Insurance companies who have ostensibly paid for sequencing would likely want some return on their investment. Thus, we argue for targeted testing for the protection of our patients.
Finally, we certainly need not wait for point-of-care testing (POC) technology to use genomic information in the perioperative setting and that was not our intent in the article also. But the fact remains that the majority of our patients are not seen 30 days in advance of surgery. This goal may be more practical in an accountable care organization, where patients receive all their care within a single health care system. Since technology is advancing at a very rapid rate, the use of POC testing in the perioperative period may fill the gap for those patients not seen in advance. POC testing or technology in general will not be the impediment in precision medicine as we have stated. Unraveling the interdependent functioning of our genome and its effect on the outcomes of clinical interest will be a far more formidable challenge for clinical medicine.