Remarks as prepared; not a transcript.

Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS
United States Surgeon General
U.S. Department of Health and Human Services

Meeting of the National Coalition for Health Professional Education in Genetics (NCHPEG)

Thursday, January 27, 2005
Bethesda, Maryland

"The Importance of Family History in Health Care"

Thank you, Alan, for that kind introduction. [Dr. Alan Guttmacher, Deputy Director of the National Human Genome research Institute, National Institutes of Health, HHS]

It is a real pleasure to be here among friends and colleagues.

I remember as a first-year med student taking introductory microbiology, virology, and biochemistry at the University of California/San Francisco, seeing first-hand the seeds of what would later grow into the biotech revolution we are in the midst of right now. Two young virology/microbiology instructors frequently and passionately told us of their research: their names were Harold Varmus and Mike Bishop. As you know, they went on to win a Nobel Prize for their work just a few years later.

I also had a biochemistry teacher who was equally passionate in his research in bioengineering, a then-futuristic complex concept. His name was Herb Boyer, who went on from meager beginnings - driving a beat-up old car and teaching me, and my classmates - to found Genentech; a world leader among bio-tech companies.

At the time, their work seemed very futuristic, almost incomprehensible. But we live in a time when yesterday's science fiction is becoming today's science fact.

Priorities

When President Bush nominated me to be Surgeon General, he asked me to focus on three priorities to maintain and improve the health of the American people. All three of my priorities are very strongly evidence-based. They are:

  • First, Prevention. - What each of us can do in our own lives and communities to make ourselves and our families healthier.
  • Second, and new to the Office of the Surgeon General: Public Health Preparedness. We are investing resources to prevent, mitigate, and respond to all-hazards emergencies. and
  • Third, Eliminating Health Disparities, an issue about which President Bush is also passionate.

Woven through each of these priorities is improving health literacy. Over the past two years, I've worked to improve Americans' health literacy, and this year we are focusing on children in what we are calling "The Year of the Healthy Child."

Health Literacy

By improving health literacy, we can save lives through prevention and early diagnosis.

Because the more people know about health, the better they take care of themselves and their families.

We are in an era when public health messages are transitioning away from a convergence on population-based averages to focus on individualized prevention. Variations in our genes, environment, and the lifestyle choices we make determine our overall health.

The field of genomics allows us to determine our nonmodifiable risk factors, and in so doing, target modifiable risk factors - allowing focused disease prevention and health promotion strategies.

We are reaching the era of "personalized" disease-prevention. But we have a long way to go before to realize the full potential of this new age.

For example, millions of Americans have heard about the success of the Human Genome Project, but most people don't know how it applies to them. That project cost $2.7 billion. It has been a tremendous investment in our future. It's truly the Fort Knox of science and medicine.

Family History Initiative

Americans already know that their family health history can be useful, but relatively few people have tried to collect it in an organized way.

According to the Healthstyles 2004 Survey conducted by the CDC, 96 percent of Americans believe that knowing family history is important to their health.

The survey also shows, however, that only one-third of Americans have ever tried to gather and organize their families' health histories.

That's why we introduced the "U.S. Surgeon General's Family History Initiative." I want to thank the National Coalition for Health Professional Education in Genetics for your support of the Family History Initiative.

We've focused on a single, simple concept: knowing your family's medical history can save your life. Surveillance can lead to early detection. And early detection can lead to more effective treatments. It's a well-proven strategy.

But many people don't take preventive action because they don't think they are at risk.

"My Family Health Portrait"

To close that gap, we launched a new computer-based tool called "My Family Health Portrait."

This tool helps people to collect and organize family health information in an easy-to-use format. It's available online and in print versions - in English and in Spanish.

Hundreds of thousands of Americans have downloaded it on their computers and we have distributed thousands more copies of the paper version of "My Family Health Portrait."

National Family History Day

Thanksgiving 2004 was our country's first annual National Family History Day. This focus on collecting family history will become an annual event.

Later today, Alan will discuss some of our future plans for this initiative, which will in many ways converge with our 2005 agenda: The Year of the Healthy Child.

The Year of the Healthy Child

We know that the health needs of children grow into the health problems of adulthood, so this year I will be taking a hard look at ways to improve the health of children both domestically and internationally.

We are starting with pregnancy care, and then early childhood development, including such issues as the importance of breastfeeding and on-time immunizations.

As a child grows, so do the child's health needs, so the Office of the Surgeon General will address - among other things - childhood obesity, injury prevention, healthy indoor environment, child abuse prevention, drug and alcohol use prevention, and safe teen driving.

Building on my "50 Schools in 50 States Initiative," we will continue to work with partners and school districts to reach into classrooms across the country to encourage students to stay in school. In addition, we will encourage more students, especially minorities, to focus on excelling in math and in the hard sciences.

And finally, because the enthusiasm of children and teens is often overlooked within their communities, we will work to harness their energy and partner them with local institutions to promote volunteerism, civic responsibility, and patriotism.

But I can't do it alone. I need you - your expertise, your experience, and your passion. We intend to make a big impact.

Pre-Pregnancy and Pregnancy

For example, part of this year's focus during The Year of the Healthy Child is on healthy choices that everyone should make when considering having children.

An example is the use of folic acid supplementation to ward off neural tube defects. Research has shown that, if taken before and during early pregnancy, folic acid can prevent 70 percent of these birth defects.

All women considering pregnancy should supplement their diet with 400 micrograms of folic acid each day. However, women whose family history shows a high risk of neural tube defects should take more - up to four milligrams of folic acid, 10 times the amount recommended to the population.

Every child deserves a rigorous, complete family history in his or her medical chart. It should actually be completed before the child is even conceived.

This is another example of genomics is bridging population-based health tools with individualized medicine.

Charge and Closing

The genetics revolution also brings challenges that we must recognize and respond to effectively.

As we look into the future, it is not inconceivable that all of the variations in our genome could some day be tested for less than $1,000, or less. While this might seem like we're shooting for the moon, until we fully succeed, we'll be falling among the stars of medical promise.

Our success isn't without danger, however. There is a moral construct that must guide science. For example, I recently saw an ad on the web advertising a susceptibility test for addictive behavior. The ad asks, "Are you concerned about your children's future? Does your child have the genetic trait that leads to disruptive and addictive personalities? D-N-A based testing can help you to understand and manage a child's behavior before it gets out of control."

These are ridiculous claims, and such egregious misuse of genetic testing in the public domain will destroy the remarkable progress if we do not continue to educate the public.

The Human Genome Project is our Fort Knox of medicine. It is a national treasure, but we must guard this precious resource and keep it in good hands. Science has the potential now to outpace human understanding of the ramifications of what we are undertaking. We need to move carefully but deliberately.

I have faith that most scientists care a great deal about the applications of their discoveries, and will not step over lines drawn by societal conscience.

And it is incumbent on all of you to also protect science by educating all Americans.

As I promote the public health of our nation's children, I will also keep the public informed of the importance of genetics for personalizing prevention.

Thank you for partnering with the Department of Health and Human Services and the Office of the Surgeon General to help improve the health and health literacy of all Americans. Thank you for all you're doing, and I look forward to continuing to work with you.

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Last revised: January 8, 2007