Transcript of "Personalized Medicine" Podcast
Adam Dormuth: Hello and welcome to the National Jewish podcast series. My name is Adam Dormuth, media relations specialist, and I'm here today with National Jewish CEO Michael Salem and today we're going to talk about personalized medicine. So Dr. Salem, let's get started. How would you define "personalized medicine?"
Michael Salem, MD: Personalized medicine is a relatively new concept but it's one that really came into being coincidentally with the sequencing of the human genome and an enormous amount of information and new discoveries that really bring forward the concept of perhaps practicing medicine in a more precise fashion. Now medicine, for as good as we are in this country, and what we do at National Jewish, is still largely reactive in nature. Something happens, you have a series of symptoms, and you go and seek treatment in a reactive way. Well now, the concept is that we'll utilize the fruits of the sequencing of the human genome and all of the amount of genetic information to turn medicine into more of a proactive fashion or predictive fashion or more personalized fashion where one brings together the research and the clinical care together at the point of the patient in order to provide not only medical care, but the concept of total healthcare and wellness on behalf of the patient.
AD: So more specifically, how will change help patients who're managed by physicians?
MS: I think it's already changing the way physicians manage patients. Just to give you an example of the programs here at National Jewish, we seek to put together these integrated clinical and research programs so that when someone comes to National Jewish with an ailment, then they'll get whatever predictive genetic testing is available. For example, there are predictive genetic tests available for whether patients or certain subsets of patients are going to get breast cancer or colon cancer or how severe their chronic obstructive pulmonary disease or emphysema is going to be. As part of this program, patients can potentially participate in basic science protocols where basic scientists are waiting for cells from those patients. They can contribute their DNA or tissues to an institutional Biobank so they can be further studied down the line to see if new earlier diagnostic tests can be developed. Patients have the choice if there is chemoprevention available for their potential disease process; like I take Lipitor so that maybe I won't develop coronary artery disease. We have a smoking cessation program at National Jewish, which we do for five states around the country so that patients can quit smoking as a way towards chemoprevention or other epigenetic modification.
What's the most advanced imaging for the patient to receive? We are building on the third floor of our institution our Institute for Advanced Biomedical Imaging, which will have the latest in diagnostic care, but more importantly, will approach the concept of what I call "advanced diagnostics" where you bring together the latest imaging techniques and technology with the clinical reference labs and those predictive tests so you can tell the difference earlier on between potentially benign and malignant disease. And then as it relates to therapies, what kind of targeted therapies are there so one doesn't have to pull out the heaviest guns every time. That's this concept of living with cancer as opposed to killing every cancer cell, which may kill your cells as well. And what are the more targeted therapies that we could do and what clinical trials can the patient potentially participate in and then what kind of disease management or disease tracking do we have after the patients leave in order to be able to pick up signs earlier on that the condition might need intervention. So this whole change in the concept, to be more personalized and to be more specific, and to integrate our research and clinical efforts-that's what we hope to achieve in personalized medicine at National Jewish. That's why what we're trying to do is take the science, the science that's invented here and at many other places throughout the country, and bring it forward in terms of transforming peoples' lives.
AD: Alright Dr. Salem, can you provide examples of how personalized medicine can help doctors prescribe medication?
MS: Well that's a very important question. That field has another name to it called pharmacogenetics or pharmacogenomics, and let's take a couple of examples that are relevant to that. Just several years ago, let's say a patient went to a physician's office and they were diagnosed with depression. Some of the most commonly prescribed drugs are antidepressants. A physician would normally prescribe such a medication not based on anything other than the patient's symptoms but there are a number of different classes of antidepressants for the physician to choose from. But let's say the patient then would go home and develop not an improvement in their condition, but perhaps some further symptoms or increased symptoms associated with the depression. The patient then goes back to the doctor and says "Doc, I don't think it's working, I'm having some side-effects," and then the doctor can make a number of choices, one of which would be to increase the dose of the medicine that the patient is on because it may be that the physician thought it wasn't working. In other words, it's just an educated guess. Well, the patient then goes home and then begins to have increased side effects. The patient comes back to the doctor who then changes to a different class of medications. It just so happens that there are genetic tests available now that can be specific to the patient's makeup that will allow us to potentially choose right up front a class of antidepressants that the patient might be more responsive to. In other words, to decrease the guesswork as it relates to being more specific about how we prescribe the patient's medication.
Another example might be an elderly patient who comes to the doctor with high blood pressure. The doctor picks a beta-blocker for the patient, which is a class of medications that can help decrease a patient's blood pressure. The patient goes home and then only has a partial response to that blood pressure medication in terms of bringing that blood pressure down to normal. The patient goes back to the doctor who says, "Well, that's not good enough, let's increase the dose of that medication." Patient goes home, and though the blood-pressure comes down towards normal, the patient has rather significant side-effects, gets dizzy and has other problems, then goes back to the doctor because he heard a friend of his is on a different class of medication and maybe he could be changed to that. Well the idea is that now there are genetic tests available, which might help the doctor better understand how the patient's going to metabolize those medications. So therefore, a different choice or a more precise choice can be made based on the patient's genetic makeup upfront. Those are two examples that are right here and available right now, but we need to do patient education and some physician education on these tests and how they're available and the right way to interpret them because that's very important as well.
AD: So Dr. Salem, how close are we to seeing personalized medicine in the everyday care of patients?
MS: I think that that's another very good question. Our strategy here at National Jewish, this personalized medicine strategy that's integrating our clinical and research programs, is a ten-year vision where we want to bring these innovations forward, but in a very practical sense. We're not interested in the ethereal; the question is "how can you bring these novel changes into everyday practice?" One of the things that we pride ourselves on at National Jewish is that it is a unique healthcare experience to come here. When patients come through the door, no matter how thick their chart is or how many CD's they come with, in terms of bringing their patient records-and a third of our patients come from around the world-that our commitment to them is that no matter what, we're going to do everything possible to figure it out. We're going to do everything possible at National Jewish to figure out what's wrong and then treat them and give the patient and family all the education that they need. Part of leading as National Jewish over the next decade is to try to bring this change in medicine forward to into our everyday practice. So what we have set up relative to our six areas of emphasis in personalized medicine going forward (asthma, chronic obstructive pulmonary disease [emphysema], heart disease, lung cancer, allergy and immunology) is we bring our researchers and clinicians together to look at each and every patient.
For example, the way that we're bringing this into practical use is that... take one disease, say COPD, here at National Jewish. One day a week, everyone associated with COPD sits down at the same table and has lunch together. And every patient that came to National Jewish with this diagnosis in the past week is discussed. At the table are the researchers, the clinicians, the docs, the nurses, the rehabilitation specialists, the psychiatrists, the psychologists, everyone associated in treating these disease states are here at the table. And then that way you understand and utilize these tools not only as they relate to genomics, but enabled by electronic medical record, enhanced genetics capability, and these other tools, like the Institute for Advanced Biomedical Imaging, as well as others in order to bring all of this together in a very practical sense for patients. We do an enormous amount of research at National Jewish, an enormous amount of clinical research and clinical trials, and by paying attention to detail, and bringing these services together, we think-with the proper testing and the proper trials-we can bring these new technologies and techniques into clinical practice in a more accelerated fashion.
AD: Dr. Salem, with this approach to medicine, a question may come up: is there a risk of genetic discrimination from employers and/or insurers?
MS: I think that that's an important question and something that we pay a lot of attention to. There's an enormous amount of data associated with the new genetic, proteomic, and other information that we're able to glean now from patients, and it's most important that we utilize those discoveries to improve healthcare and wellness care in the United States. The information that we get is specific to the patient and it's important as we put tissue or other DNA into our Biobank and other repositories that that data is anonymized, in other words made anonymous, and cannot be used in any way for genetic discrimination. As we bring together our centers and many great centers around the country, because these ideas of personalized medicine are not unique, the idea is how can we bring our ideas together with others and look at these disease states and get a better idea in terms of more specific therapies, earlier diagnosis, and really put those things into practical use. But we cannot use any of that information in order to discriminate against others; otherwise, the patients will not provide us with that information.
AD: Finally, with this personalized medicine approach, what other aspects do you think are important for patients to realize regarding personalized medicine that maybe we haven't covered already?
MS: I think that it's a very important part of changing the paradigm in medicine going forward. And though many people in the United States believe that the healthcare they get and their doctor is very good, there are many issues we have in medicine. We hear a lot now about healthcare crisis in this country, and we don't do as well as we think with regards to infant mortality and our survival rate compared with other countries. That said, the ideas and solutions embodied within this concept are a way for a medical center like National Jewish that says "this is the way we're going to treat patients, this is the way we're going to research, this is the way we're going to educate the next generation of docs and scientists." We think it's a set of ideas and solutions that will allow National Jewish to continue to do what it's done for the last so many years, and that is lead in medicine and really do things that are good for patients and their families while completely maintaining that human touch in understanding that it's the patient that comes first.
AD: An exciting time for National Jewish.
MS: I think it is an exciting time for National Jewish. The faculty and staff are really remarkable people here. The science that's been discovered here and enabled by other great institutions around the world and the collaborations we have. We're committed to patient care. We're committed to leading and research. I've never been at an academic medical center or a teaching medical center that was more dedicated to its mission by its people and I'm honored to be here at National Jewish.