San Diego – Advances in genomic medicine are expected to accelerate most notably in five key areas in 2011, following a year when the field made important strides toward addressing deep-rooted inefficiencies in health care delivery.
That’s the opinion of Dr. Eric Topol, chief academic officer of Scripps Health and director of the Scripps Translational Science Institute in San Diego. Dr. Topol says he expects momentum to continue in 2011 in the following top five areas.
1. Prescription Medications. Patients in the United States spend more than $300 billion a year on prescription medications, but in most cases the drugs either don’t work, cause serious side effects, or both. Now, genomic information is providing valuable intelligence to guide more effective use of medications. Pharmacy benefit managers (PBMs) including Medco and CVC/Caremark recently started genotyping a portion of the 100 million patients they cover for compatibility with Plavix and other medicines. These two companies will likely expand screening to more patients and additional drugs in 2011, with other PBMs almost certain to follow suit. Genetic screening for drug therapy will reduce waste and costs, while improving patient care. This needs to be promoted at the local health system level, and not just through PBMs.
2. Cancer. Genomic sequencing is helping doctors more precisely define the “driver” genetic mutations associated with the development and progression of cancer. And now that sequencing is becoming far less expensive, the ability to sequence everyone with a serious cancer may soon be within reach. Besides an improved capacity to zero in on the driver mutations, another important development is taking shape: the choices of drugs that work on these mutations is expanding, with some already being marketed and others in the pipeline. This is significant, since it’s likely that there will be a combination of drugs that will work on the pathway that has gone off track. Using genomics to find and target cancer tumors will expand worldwide in 2011.
3. Diabetes. The scientific community is starting to learn a great deal more about the genomics of diabetes, a growing epidemic that affects 300 million people worldwide. Diabetes has long been perceived in terms of type 1 and 2, but the genome has revealed numerous variants that predispose people to a great many other forms of the disease. For example, some people are unable to transport or make insulin; others may be resistant to insulin at the tissue level, or the insulin can’t get out of the cell. Expanding and refining the number of subtypes of diabetes will enable physicians to match up therapies, rather than the current approach of prescribing a sea of drugs with hit-or-miss results. More efforts are expected to be focused in this area in 2011, along with greater adoption of wireless monitoring of glucose levels.
4. Physician Education. Only about 10 percent of America’s doctors believe they have enough knowledge of genetics to use it in their medical practice, according to a national study. Yet the vast majority of patients indicate their doctors are the ones they trust with their genomic data. Addressing this paradox will be the focus of the College of Genomic Medicine when it launches in 2011. This online learning and credentialing program will take participants through approximately eight hours of instruction on various aspects of genomic medicine, followed by exam they must pass to be certified. When it comes to educating physicians, the stakes are high. Without getting doctors up to speed, all of the new genomic knowledge – particularly in guiding drug therapy – will be wasted.
5. Personal Gene Tests. Despite being castigated by the medical community and government regulators for their inability to accurately predict disease risk, consumer gene tests will continue to offer important benefits to patients. In addition to their main practical application – guiding drug therapy on an individualized basis – these tests can help prompt many consumers to get appropriate health screening tests they otherwise may have forgone. For example, only about half of those 50 and older get colonoscopies as recommended. There is plenty of room for patients to improve their adherence to screening guidelines across all diseases, and personal gene tests may provide an important tipping point for many.
Founded in 1924 by philanthropist Ellen Browning Scripps, Scripps Health is a $2.3 billion, private not-for-profit integrated health system based in San Diego, Calif. Scripps treats a half-million patients annually through the dedication of 2,500 affiliated physicians and 13,000 employees among its five acute-care hospital campuses, home health care services, and ambulatory care network of physician offices and 22 outpatient centers and clinics.
Recognized as a leader in the prevention, diagnosis, and treatment of disease, Scripps is also at the forefront of clinical research, genomic medicine, wireless health care and graduate medical education. Scripps has been recognized by Thomson Reuters as one of the Top 10 health systems in the nation for quality care. With three highly respected graduate medical education programs, Scripps is a longstanding member of the Association of American Medical Colleges. More information can be found at www.scripps.org.