Friday, October 12, 2007

Wylie Coyote? No. Wylie Burke!

In the Journal of the American Medical Association this week an article by Dr Wylie Burke has surfaced. If you don't know who Dr Burke is, then you are in the dark when it comes to true "realism" about the genome and personalized medicine.

Dr. Wylie Burke is Professor and Chair of the Department of Medical History and Ethics at the University of Washington. She is also Principal Investigator of the University of Washington Center for Genomics and Healthcare Equality, an NIH-funded Center of Excellence in Ethical, Legal, and Social Implications (ELSI) Research. Her research addresses the social, ethical and policy implications of genetic information.

From the article:

"ENTHUSIASTIC PREDICTIONS ABOUT PERSONALIZED MEDICINE have surrounded the sequencing of the human genome. As commonly used, the term predicts a leap forward in disease prevention and drug treatment, based on knowledge of individual genetic susceptibilities."

This is true. The media as well as the corporate world have "promised" some outlandish things in this space.

"Nevertheless, claims of a new medical paradigm based on genomics merit careful scrutiny. The exhortation to prepare for a “genomics revolution” often assumes that genetic risk is different in kind from other health risks."

Well, Dr Burke.....I would say that genetic risk can at times be worse than other health risks, but not at all times. This requires a nuanced knowledge base and often can not be finessed by the public or even some physicians.

"Each new genetic test will need to be evaluated and assessed to demonstrate that the overall health benefits exceed the harms before it is implemented in practice. The fundamental
principle is that genetic risk information will be useful only if it guides more effective, or more cost effective, use of medical interventions than can be achieved without the risk information."

This is precisely in line with what we tell physicians. There is no need to go off testing everyone, without good data. There are some scientists who say that data is appropriate, but unless this is peer reviewed or applicable clinically, the claim is hooey.

Here's the part I love

Personalized medicine has always been a component of good medical practice. Genetic tests may provide new tools, but they do not change the fundamental goal of clinicians
to adapt available medical tests and technologies to the individual circumstance of their patients. As genetic tests become widely available, personalized medicine will include
assisting patients to make wise use of genetic risk assessment, taking into account the cautions discussed in this article. When genetic testing is used, the personalized nature
of the care will extend well beyond the patient’s base pair sequences.

The good Dr Burke is pointing to careful clinical care and continuity of care being key to personalized medicine. I agree that not all personalized medicine is genetic. That is why no report printed on a sheet of paper will achieve the goal of personalized medicine.

The Sherpa Says: When you read this article please keep in mind that Dr Burke is a geneticist!


Hercules said...

none of the presentations at the personalized medicine conference this week mentioned the physician, except in terms of being bypassed by the consumer... it's better that the Sherpa wasn't there, he might have been tempted to push everyone off the mountain...

Steve Murphy MD said...

I am supposed to lead people up the mountain. Why would I want anyone to perish. You should check out the other personalized medicine conference going on at Harvard this weekend. It is full of physicians.
Including myself.....