Personalized Medicine: The Brake vs. The Accelerator
A recurring theme on the blog – and presumably on every other medicine and science blog – has been the push toward personalized medicine, the utopian future where every patient receives individualized care for a disease or even the genetic risk of disease. But the road to that future world of health care has been slower than some experts anticipated, with disappointing clinical trials, scientific setbacks and regulatory hurdles all acting as speed bumps. Those obstacles are partially why National Institutes of Health director Francis Collins was dinged this week in a New York Times article for promising “a complete transformation in therapeutic medicine” within a decade or two of the Human Genome Project’s completion…ten years ago.
So it was interesting to see Collins’ revised opinion on the timeline for personalized medicine this week in the New England Journal of Medicine, in an editorial co-written with FDA Commissioner Margaret Hamburg. It’s a strange partnership in some ways: the country’s top scientist and the country’s top regulator. The editorial reads accordingly, with a first half marked by the go-go optimism of Collins followed by the “woah, let’s slow down” realism of Hamburg.
Still, there are some interesting initiatives within. Collins gives the glass-half-full version of the New York Times’ Human Genome Project assessment, stating that hundreds of disease-related gene variants have been characterized and are now promising drug targets. The issue, Collins claims is the lack of financial incentives for companies to pursue those targets, something he hopes to fix by allowing the NIH to step in and do the preclinical “Valley of Death” work that scares off pharmaceutical companies. Collins also promises an expanded effort to establish tissue banks and genetic databases from clinical trials and epidemiological studies such as the Framingham Heart Study, to enable better research into biomarkers that predict disease or response to treatment.
On the flipside, Hamburg argues that extreme caution should be employed in approving tests for those very biomarkers. Her argument – that most current tests are inaccurate or misleading – is backed up by the FDA’s recent move to more aggressively regulate test marketed for at-home use. While the editorial offers a table of three tests approved to predict a patient’s response to a cancer drug such as Gleevec or cetuximab, Hamburg writes that some 2,000 genetic tests are currently used by clinical laboratories – some FDA-approved, some not. The editorial promises a genetic testing registry that will offer consumers and physicians information about the tests, but promises that the agency will keep a close eye on tests that “are broadly marketed to laboratories or the public.”
If that sounds all a bit good cop/bad cop, it’s true. The key will be in the balance between the forces pushing personalized medicine forward and those entrusted with testing its validity. As Collins and Hamburg put it, “When the federal government created the national highway system, it did not tell people where to drive – it built the roads and set the standards for safety…We are now building a national highway system for personalized medicine.”
More World Cup Science
When I wrote my World Cup science piece last week, I didn’t realize that several scientists were holding back their timely soccer-science articles until the tournament was in full swing. But sure enough, a flood of new research has crossed the wires in the past week, about everything from the controversial vuvuzela horns to the age-old debate of “soccer” vs. “football.”
In the latter category, a team from Oxford University and the University of Kentucky used Google Maps to find out which country is most obsessed about the game, and whether they call it by its English or American nomenclature. The linguistic winner was, as you might expect, “football,” but the other winner was a surprise to me: African nation Algeria, which had an even higher proportion of references to the beautiful game than England (their opponents today, by coincidence).
A similar crossover of internet technology and soccer was published this week in the journal PLoS ONE, by a trio of scientists across town at Northwestern University. Here, the researchers applied social networking philosophy from sites like Twitter and Facebook to the number of passes employed by teams in the European Championships two years ago. Teams that constructed the strongest “ball flow” network were deemed the most successful – a theory born out by the fact that the top three performances under their model were by Spain, who won the tournament. Of course, Spain lost their opening World Cup match, so perhaps a revision is in order.
Finally, the vuvuzelas have been the big story of the World Cup’s first week for people who don’t care about soccer, and some quickie science has sprung up around the buzzing instruments. The Telegraph measured the loudness of the vuvuzela, and reported that it clocked in at 127 decibels, louder than a lawnmower or a chainsaw. But then the Wall Street Journal Health Blog struck back with comparison figures that showed a vuvuzela-ridden soccer match was still quieter than your typical NFL or NASCAR event. But if you still can’t handle the hornet-hum, Lifehacker featured several methods for eliminating them from your home broadcast by cutting off the signature vuvuzela frequency. Personally, I just use the mute button. (links via our Stanford friends at SCOPE).
(By the by, if you’re the betting sort, UChicago alum Nate Silver applied his mathematical mind to predict World Cup outcomes)