Flu and Personalized Vaccines

As I sit here shivering, febrile and with myalgias, I had a thought. "Hey wait a second....I got the flu shot this year". Yes, it is true. For the first time EVER in my adult life I had received the flu vaccine. It's funny, becuase if you think about it, Flu Vaccine IS personalized medicine/Genomic Healthcare.

You may be saying, HUH? But it is the truth. The flu vaccine is a combination of two genes...well the protein products of those genes. Yes, much like humans there are several different types of the "flu" Influenza virus. They are classified according to these genes Hemagluttinin and Neuraminidase.

Hemagglutinin also called H and then subtyped by number, is useful for the little influenza to stick to the cells it wishes to invade.

Neuraminidase also called N and then subtyped by number is used for the "little bastard" (sorry, it is just the cytokines in my body speaking) to escape from infected cells and spread to other cells.

So when a vaccine is made they actually put components of these subtypes together with their "Best Estimate" of which viruses are likely to infect during a given year. Hence "Personalized Vaccine Medicine"

Well this year guess what. Our best guess was.....WRONG and now I sit here with the flu. This is not the only thing wrong in personalized medicine land. We have long known that sometimes we make a mistake in subtyping a woman's breast cancer for the Her-2 protein. Now we are finding a better way....through chickens. So how's that Chicken Soup for the Genomic Soul. Her-2 is used to direct therapy of a Her-2 Monoclonal antibody. For more, see the Personalized Medicine article.

The Sherpa Says: The best laid guess is as good as anybody's This is why we need to always view these technologies very carefully. Imagine getting a flu shot thinking you will have better protection, only to get the flu for the first time in years. Now imagine taking herceptin only to find out it doesn't work for you. We have to be careful and double check what we are given and what our results are. Too many people take printed reports AND clinicians at face value. While usually a good thing (Only if we understand the language) it can have some bad outcomes. Including my own illness ;)

Garbage In, Gospel Out

There is an old saying called "Garbage In, Garbage Out" This saying was coined by George Fuechsel an IBM hack. Other such terms like FUBAR, SNAFU, and even KIBO reflect some of the issues we have going on with personalized medicine and even medicine as a whole.

This term is especially poignant today when the Wall Street Journal casts a shadow on the field of pathology and personalized medicine testing for breast cancers. The drug Herceptin is one of the Vanguards of what I called personalized molecular medicine therapy.

You see, Herceptin therapy is targeted towards a certain type of breast cancer. In this type of breast cancer your cells have a protein located on them that can encourage cells to grow. When this protein is blocked, cells die. Therefore, Cancer is beaten back. The catch, if you don't have this protein in your cancer, you don't respond to Herceptin.

This is the paradigm for personalized medicine. We test your cancer to see if it has this molecule. If it does great we give you Herceptin. If it doesn't, too bad, it's regular chemo for you. But what happens when GIGO takes over? What if the tumor sample is bad? What if the lab analysis is bad? What happens when the lab technicians are inexperienced? Garbage In...

So what do you get? Patients on Herceptin who may have not benefited from this therapy and perhaps would have benefited from the standard treatments. Simply because their test results were reported as positive. Even if this report was a mistake. You see, doctors got caught up in the worst acronym of all "Garbage In, Gospel Out" This term was coined to essential remind us how we often treat computer output as infallible. This is the very same case in medicine with pathology laboratories. I often go to the lab myself to double check results. Time consuming? Yes. Life saving? Absolutely!

The Sherpa Says:

What happens if the same thing occurs with whole genome analysis? Last time I checked, Copy Number Variation, Non-coding sequence, "Dark Matter" are all part of our genomes. Do we have a good handle on how well we can sequence this stuff? More importantly, we must not let genomes become Garbage In, Gospel Out"