Technological advancements in genetic research are crucial for nations aiming to uplift their population’s quality of life and ensure a sustainable economy. Genomic information and biotechnology can enhance healthcare quality, outcomes, and affordability. The “P4 medicine approach”—predictive, preventive, personalized, and participatory—aligns with objectives like promoting long-term well-being, optimizing resources, and reducing environmental impacts, all vital for sustainable healthcare. This paper highlights the importance of adopting the P4 approach extensively. It emphasizes the need to enhance healthcare operations in real-time and integrate cutting-edge genomic technologies. Eco-friendly designs can significantly reduce the environmental impact of healthcare. Additionally, addressing health disparities is crucial for successful healthcare reforms.

Acosta, J. N., Falcone, G. J., Rajpurkar, P., Topol, E. J. (2022). Multimodal biomedical AI. Nat Med. 2022 Sep;28(9):1773-1784. doi: 10.1038/s41591-022-01981-2. Epub 2022 Sep 15. PMID: 36109635.

Alliance for Natural Health. (2008). Sustainable Healthcare—Working towards the Paradigm Shift. Retrieved December 24, 2023, from https://www.anhinternational.org/wp-content/uploads/old/files/100617-SustainableHealthcare_White-Paper.pdf

Aquino, R. P., Barile, S., Grasso, A., Saviano, M. (2018). Envisioning smart and sustainable healthcare: 3D printing technologies for personalized medication. Futures, 103, 35–50. https://doi.org/10.1016/j.futures.2018.03.002

Asnicar, F., Berry, S. E., Valdes, A. M., Nguyen, L. H., Piccinno, G., Drew, D. A., et al. (2021). Microbiome connections with host metabolism and habitual diet from 1,098 deeply phenotyped individuals. Nature Medicine, 27, 321–332.

Babu, M., Lautman, Z., Lin, X., Sobota, M. H. B., Snyder, M. P. (2024). Wearable Devices: Implications for Precision Medicine and the Future of Health Care. Annu Rev Med. 2024 Jan 29; 75: 401-415. doi: 10.1146/annurev-med-052422-020437. Epub 2023 Nov 20. PMID: 37983384.

Belcher, A., et al. (2020). Global approaches to genomic medicine implementation. Science Translational Medicine, 12, eaax0911. https://doi.org/10.1126/scitranslmed.aax0911

Bilkey, G. A., Burns, B. L., Coles, E. P., Mahede, T., Baynam, G., Nowak, K. J. (2019). Optimizing Precision Medicine for Public Health. Front Public Health. 2019 Mar 7; 7: 42. doi: 10.3389/fpubh.2019.00042. PMID: 30899755; PMCID: PMC6416195.

Boffa, D. J., Nelson, H., Mullett, T., Opelka, F., Turner, P. L., Shulman, L. N. (2024). Privacy on the Road to Personalized Medicine. J Natl Compr Canc Netw. 2024 Jan;22(1D):1-5. doi: 10.6004/jnccn.2023.7101. PMID: 38176100.

Boffetta, P., and Collatuzzo, G. (2022). Application of P4 (Predictive, Preventive, Personalized, Participatory) Approach to Occupational Medicine. Medicina del Lavoro, 113(1), e2022009. https://doi.org/10.23749/mdl.v113i1.12622

Chiang, J., Chua, Z., Chan, J. Y., Sule, A. A., Loke, W. H., Lum, E., Ong, M. E. H., Graves, N., Ngeow, J. (2024). Strategies to improve implementation of cascade testing in hereditary cancer syndromes: a systematic review. NPJ Genom Med. 2024 Apr 3;9(1):26. doi: 10.1038/s41525-024-00412-0. PMID: 38570510; PMCID: PMC10991315.

Cinti, C., Trivella, M. G., Joulie, M., Ayoub, H., and Frenzel, M. (2024). The roadmap toward personalized medicine: Challenges and opportunities. Journal of Personalized Medicine, 14(6), 546. https://doi.org/10.3390/jpm14060546

Curtin, M., Somayaji, D., Dickerson, S. S. (2022). Precision Medicine Testing and Disparities in Health Care for Individuals With Non-Small Cell Lung Cancer: A Narrative Review. Oncol Nurs Forum. 2022 May 1;49(3):257-272. doi: 10.1188/22.ONF.257-272. PMID: 35446830.

D’Gama, A. M., Agrawal, P. B. (2023). Genomic medicine in neonatal care: progress and challenges. Eur J Hum Genet. 2023 Dec;31(12):1357-1363. doi: 10.1038/s41431-023-01464-z. Epub 2023 Oct 4. PMID: 37789085; PMCID: PMC10689757.

Dabas, P., Danda, A. (2023). Revolutionizing cancer treatment: a comprehensive review of CAR-T cell therapy. Med Oncol. 2023 Aug 22;40(9):275. doi: 10.1007/s12032-023-02146-y. PMID: 37608202.

Dharani, S., Kamaraj, R. (2024). A Review of the Regulatory Challenges of Personalized Medicine. Cureus. 2024 Aug 27; 16(8): e67891. doi: 10.7759/cureus.67891. PMID: 39328627; PMCID: PMC11425062.

Equils, O., Bakaj, A., Wilson-Mifsud, B., Chatterjee, A. (2023). Restoring Trust: The Need for Precision Medicine in Infectious Diseases, Public Health and Vaccines. Hum Vaccin Immunother. 2023 Aug 1;19(2):2234787. doi: 10.1080/21645515.2023.2234787. Epub 2023 Jul 19. PMID: 37465958; PMCID: PMC10361134.

Flores, M., Glusman, G., Brogaard, K., Price, N. D., Hood, L. (2013). P4 medicine: How systems medicine will transform the healthcare sector and society. Personalized Medicine, 10(6), 565-576. https://doi.org/10.2217/pme.13.57

Fraser, H., Pai, A. (2014). The role of genomic medicine in transforming healthcare. Health Policy and Technology, 3(4), 223-225. https://doi.org/10.1016/j.hlpt.2014.10.005

Guérin, J., Laizet, Y., Le Texier, V., Chanas, L., Rance, B., Koeppel, F., et al. (2021). OSIRIS: A Minimum Data Set for Data Sharing and Interoperability in Oncology. JCO Clinical Cancer Informatics, 5, 256-265. https://doi.org/10.1200/CCI.20.00094

Gupta, V. K., Kim, M., Bakshi, U., Cunningham, K. Y., Davis, J. M., 3rd, Lazaridis, K. N., et al. (2020). A predictive index for health status using species-level gut microbiome profiling. Nature Communications, 11, 4635.

Henneman, L., Vermeulen, E., van El, C. G., Claassen, L., Timmermans, D. R. M., Cornel, M. C. (2013). Public attitudes towards genetic testing revisited: Comparing opinions between 2002 and 2010. European Journal of Human Genetics, 21(8), 793-799. https://doi.org/10.1038/ejhg.2012.271

Hoenders, R., Ghelman, R., Portella, C., Simmons, S., Locke, A., Cramer, H., Gallego-Perez, D., Jong, M. (2024). A review of the WHO strategy on traditional, complementary, and integrative medicine from the perspective of academic consortia for integrative medicine and health. Front Med (Lausanne). 2024 Jun 11; 11: 1395698. doi: 10.3389/fmed.2024.1395698. PMID: 38933107; PMCID: PMC11201178.

Hood, L. (2013). Systems biology and P4 medicine: Past, present, and future. Rambam Maimonides Medical Journal, 4(2), e0012. https://doi.org/10.5041/RMMJ.10112

Hood, L. (2019). How technology, big data, and systems approaches are transforming medicine. Research-Technology Management, 62, 24–30.

Horgan, D., Romão, M., Torbett, R., Brand, A. (2014). European data-driven economy: A lighthouse initiative on personalised medicine. Health Policy and Technology, 3(4), 226-233. https://doi.org/10.1016/j.hlpt.2014.10.007

Hsieh, M. J., Tsai, P. H., Chiang, P. H., Kao, Z. K., Zhuang, Z. Q., Hsieh, A. R., Ho, H. L., Chiou, S. H., Liang, K. H., Chen, Y. C. (2024). Genomic insights into mRNA COVID-19 vaccines efficacy: Linking genetic polymorphisms to waning immunity. Hum Vaccin Immunother. 2024 Dec 31;20(1):2399382. doi: 10.1080/21645515.2024.2399382. Epub 2024 Sep 10. PMID: 39254005; PMCID: PMC11404610.

Hu, H., Cohen, G., Sharma, B., Yin, H., McConnell, R. (2019). Reducing pollution from the health care industry. JAMA, 322(11), 1043–1044. https://doi.org/10.1001/jama.2019.11641

Inomata, T., Sung, J., Nakamura, M., Fujisawa, K., Muto, K., Ebihara, N., et al. (2020). New medical big data for P4 medicine on allergic conjunctivitis. Allergology International, 69(4), 510-518. https://doi.org/10.1016/j.alit.2020.06.001

Jeong, G. (2018). Estimating the effects of consumer characteristics on the intention to use direct-to-consumer genetic testing. Health Policy and Technology, 7(3), 233-238. https://doi.org/10.1016/j.hlpt.2018.06.004

Kar, A., Pant, A., Shah, R. (2024). Ethical considerations in the management of orthopedic surgery waste: Balancing environmental protection and participant safety. Cureus, 16(9), e70342. https://doi.org/10.7759/cureus.70342

Khoury, M. J., Bowen, S., Dotson, W. D., Drzymalla, E., Green, R. F., Goldstein, R., Kolor, K., Liburd, L. C., Sperling, L. S., Bunnell, R. (2022). Health equity in the implementation of genomics and precision medicine: A public health imperative. Genet Med. 2022 Aug;24(8):1630-1639. doi: 10.1016/j.gim.2022.04.009. Epub 2022 Apr 28. PMID: 35482015; PMCID: PMC9378460.

Kwon, H., Jung, E.-Y. (2018). The impact of policy on the growth of precision medicine. Health Policy and Technology, 7(4), 347-357. https://doi.org/10.1016/j.hlpt.2018.10.005

Le Texier, V., Henda, N., Cox, S., Saintigny, P. (2019). Data sharing in the era of precision medicine: A scientometric analysis. Precision Cancer Medicine, 2, 30.

Mahdi-Esferizi, R., Hoseyni, B. H. M., Mehrpanah, A. (2023). DeeP4med: Deep learning for P4 medicine to predict normal and cancer transcriptome in multiple human tissues. BMC Bioinformatics, 24, 275. https://doi.org/10.1186/s12859-023-05400-2

Manolio, T. A., Abramowicz, M., Al-Mulla, F., et al. (2015). Global implementation of genomic medicine: We are not alone. Science Translational Medicine, 7(290), 290ps13. https://doi.org/10.1126/scitranslmed.aab0194

Mesaki, K., Yamamoto, H., Juvet, S., Yeung, J., Guan, Z., Akhter, A., Yao, Y., Dickie, C., Mangat, H., Wang, A., Wilson, G. W., Mariscal, A., Hu, J., Davidson, A. R., Kleinstiver, B. P., Cypel, M., Liu, M., Keshavjee, S. (2024). CRISPR-Cas Genome Editing in Ex Vivo Human Lungs to Rewire the Translational Path of Genome-Targeting Therapeutics. Hum Gene Ther. 2024 Jun;35(11-12):374-387. doi: 10.1089/hum.2023.223. Epub 2024 May 23. PMID: 38717950; PMCID: PMC11386987.

Mills, M. C., Rahal, C. (2020). The GWAS Diversity Monitor tracks diversity by disease in real time. Nature Genetics, 52(3), 242-243. https://doi.org/10.1038/s41588-020-0580-y

Mitra, A., Barua, A., Huang, L., Ganguly, S., Feng, Q., He, B. (2023). From bench to bedside: the history and progress of CAR T cell therapy. Front Immunol. 2023 May 15; 14: 1188049. doi: 10.3389/fimmu.2023.1188049. PMID: 37256141; PMCID: PMC10225594.

Özdemir. V. (2024). Global Governance for Personalized Medicine, Politics of Uncertainty, and Pierre Bourdieu. OMICS. 2024 May;28(5):211-212. doi: 10.1089/omi.2024.0091. Epub 2024 May 6. PMID: 38709543.

Pack, A. I. (2016). Application of Personalized, Predictive, Preventative, and Participatory (P4) Medicine to obstructive sleep apnea: A roadmap for improving care? Annals of the American Thoracic Society, 13(9), 1456-1467. https://doi.org/10.1513/AnnalsATS.201604-235PS

Parums, D. V. (2024). Editorial: First regulatory approvals for CRISPR-Cas9 therapeutic gene editing for sickle cell disease and transfusion-dependent β-thalassemia. Medical Science Monitor, 30, e944204. https://doi.org/10.12659/MSM.944204

Rajam, N. (2020). Policy strategies for personalising medicine “in the data moment.” Health Policy and Technology, 9(3), 379-383. https://doi.org/10.1016/j.hlpt.2020.07.003

Redekop, W. K., Bakker, L. J., Aarts, J. (2018). Healthcare problems cannot be solved using health technologies alone: The example of precision medicine. Health Policy and Technology, 7(1), 3-4. https://doi.org/10.1016/j.hlpt.2018.01.006

Roberts, M. C., Allen, C. G. (2024). Next-Generation Public Health Genomics: A Call to Assess the Equitable Implementation, Population Health Impact, and Sustainability of Precision Public Health Applications. Public Health Genomics. 2024;27(1):30-34. doi: 10.1159/000535579. Epub 2023 Dec 21. PMID: 38128494.

Roberts, M. C., Holt, K. E., Del Fiol, G., Baccarelli, A. A., Allen, C. G. (2024). Precision public health in the era of genomics and big data. Nat Med. 2024 Jul;30(7):1865-1873. doi: 10.1038/s41591-024-03098-0. Epub 2024 Jul 11. PMID: 38992127.

Sherman, J. D., MacNeill, A., Thiel, C. (2019). Reducing pollution from the health care industry. JAMA, 322(11), 1043–1044. https://doi.org/10.1001/jama.2019.11641

Siamoglou, S., Koromina, M., Politopoulou, K., Samiou, C. G., Papadopoulou, G., Balasopoulou, A., Kanavos, A., Mitropoulou, C., Patrinos, G. P., Vasileiou, K. (2021). Attitudes and Awareness Toward Pharmacogenomics and Personalized Medicine Adoption Among Health Sciences Trainees: Experience from Greece and Lessons for Europe. OMICS. 2021 Mar;25(3):190-199. doi: 10.1089/omi.2020.0230. Epub 2021 Mar 1. PMID: 33646050.

Singer, D. R. J., Redekop, K. (2020). What is ahead for health policy and technology in the 2020s? Health Policy and Technology, 9(1), 3-4. https://doi.org/10.1016/j.hlpt.2020.02.003

Singh, A., Irfan, H., Fatima, E., Nazir, Z., Verma, A., Akilimali, A. (2024). Revolutionary breakthrough: FDA approves CASGEVY, the first CRISPR/Cas9 gene therapy for sickle cell disease. Annals of Medicine and Surgery (London), 86(8), 4555-4559. https://doi.org/10.1097/MS9.0000000000002146

Smith, M. E. F. (2012). Sustainable Healthcare: A path to sustainability (PhD Thesis). MESPOM Programme, Lund, Sweden.

The 100,000 Genomes Pilot Investigators. (2021). 100,000 genomes pilot on rare-disease diagnosis in health care—Preliminary report. The New England Journal of Medicine, 385(20), 1868–1880. https://doi.org/10.1056/NEJMoa2035790

Therianou, M., Gerou, A., Mitropoulos, K., Patrinos, G. P. (2022). The Festival of Genetics and Personalized Medicine. Pharmacogenomics. 2022 Jun;23(9):509-511. doi: 10.2217/pgs-2022-0056. Epub 2022 Jun 7. PMID: 35670264.

Tsimberidou, A. M., Kahle, M., Vo, H. H., Baysal, M. A. (2023). Johnson A, Meric-Bernstam F. Molecular tumour boards - current and future considerations for precision oncology. Nat Rev Clin Oncol. 2023 Dec;20(12):843-863. doi: 10.1038/s41571-023-00824-4. Epub 2023 Oct 16. PMID: 37845306.

Vogt, E. C., Bratland, E., Berland, S., Berentsen, R., Lund, A., Björnsdottir, S., Husebye, E., Øksnes, M. (2024). Improving diagnostic precision in primary ovarian insufficiency using comprehensive genetic and autoantibody testing. Hum Reprod. 2024 Jan 5;39(1):177-189. doi: 10.1093/humrep/dead233. PMID: 37953503; PMCID: PMC10767963.

Vosshenrich, J., Heye, T. (2023). Small Steps toward a More Sustainable and Energy-efficient Operation of MRI. Radiology. 2023 May; 307(4): e230874. doi: 10.1148/radiol.230874. Epub 2023 Apr 25. PMID: 37097136.

World Health Organization. (2013). WHO traditional medicine strategy: 2014–2023. Geneva: World Health Organization. https://apps.who.int/iris/handle/10665/92455

World Health Organization. (2017). Environmentally Sustainable Health Systems: A Strategic Document. World Health Organization Regional Office for Europe.

World Health Organization. (2022). Accelerating access to genomics for global health: Promotion, implementation, collaboration, and ethical, legal, and social issues. Geneva: World Health Organization. https://doi.org/10.1166/who.a2022

Xu, Y., Wu, Q. (2023). Awareness, understanding, and interest in personalized medicine: A cross-sectional survey study of college students. PLoS One. 2023 Jan 25; 18(1): e0280832. doi: 10.1371/journal.pone.0280832. PMID: 36696425; PMCID: PMC9876288.

Yehia, L., Eng, C. (2019). Largescale population genomics versus deep phenotyping: Brute force or elegant pragmatism towards precision medicine. NPJ Genomic Medicine, 4, 6.

Zhang, X., Zhang, H., Lan, H., Wu, J., Xiao, Y. (2023). CAR-T cell therapy in multiple myeloma: Current limitations and potential strategies. Front Immunol. 2023 Feb 20; 14: 1101495. doi: 10.3389/fimmu.2023.1101495. PMID: 36891310; PMCID: PMC9986336.

Zhang, H., Klareskog, L., Matussek, A. (2019). Translating genomic medicine to the clinic: Challenges and opportunities. Genome Medicine, 11(9). https://doi.org/10.1186/s13073-019-0622-1