Sunday, January 13, 2008

Evidence Base, Not Eminence Base for Genomic Medicine

I recently reviewed a publication in November by Muin Khoury. Muin has been championing restraint with genomic companies and medicine. In the article entitled
"Why should genomic medicine become more evidence-based?" He describes why we need to make the shift and why we haven't been so good at it. One of the biggest reasons is that the geneticists and research PhD geneticists have not needed to use evidence based medicine to publish. This is in direct contrast to large medicine trials, such as those required for blockbuster medicines. In Internal Medicine and Adult medicine, residents are raised on such evidenced based articles to guide best practices.

But where are the Internal Medicine Geneticists? What we need is a hybrid of medicine and genomics research. This is translational medicine, precisely what will be required to move genomic healthcare forward. The problem I see is that the researchers got a little carried away and the recent NEJM article threw a little cold water on them. But what the researchers have behind them now is cash and lots of it. So what will happen? I mentioned some of my ideas. What I truly think will come is that the Internal Medicine Geneticists will come out of the woodwork and start publishing translational studies. Hopefully they will collaborate with Helix Health of Connecticut, or at least with myself at Yale starting in July. Give us a call.

The Sherpa Says: If you let evidence based medicine and some of my guideposts lead the way, you will emerge from this craze better off than most.

GuidePost 1. An Odds Ratio/Relative Risk less than 2 is worthless. Always ask for the OR/RR!

Guide Post 2. Always ask for replication study data before you believe any association. You should have at least 2 replication studies.

Guide Post 3. Read the Sherpa and join the comments. Soon you can sign up for our newsletter.

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