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The Promise of Precision Medicine

Posted on Jul 11, 2016 in Uncategorized

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In this blog post, our Mills-Peninsula research partners in precision medicine at Sutter HealthWalter “Buzz” Stewart, Ph.D., MPH, vice president and chief research officer at Sutter Health, and his colleague, Gregory Tranah, Ph.D., a scientist at Sutter Health’s California Pacific Medical Center Research Institute, discuss the promise of precision medicine and the research that is taking shape in the Sutter Health network and how genomic information and big data are revolutionizing patient care.

What is Precision Medicine?

STEWART: Precision medicine represents the research foundation that leads to better ways of individualizing care for patients. Its prominence today reflects the convergence of unprecedented advances in three areas: our understanding of the biology of health and disease, and the role of genetic and physiologic factors; the rapid growth in patient digital health data; and powerful computing tools that can analyze enormous volumes of data quickly and cost-effectively. These advances are making it possible for researchers to use genetic information, blood and other biologic samples, and electronic health record data to understand disease and disease progression in ways that we only imagined in the past.

What kind of precision medicine is Sutter Health doing?

TRANAH: To have a meaningful impact on our patients in the near term, we are initially focusing on two areas. First, we want to be able to identify which patients with a given condition will progress and which will not. This will allow us to more precisely intensify care for some patients and offer reassurance to the many others whose conditions are likely to remain stable. Our research also has a predictive component, which means using all of this data to identify patterns that can tell us who is likely to develop a disease. Second, we want to improve treatment decision-making. For many conditions, the only way for doctors to determine which available drug or treatment will work best for a given patient is trial and error. Precision medicine can change that. By identifying subtypes of disease at the molecular level, we will begin to understand how each patient will respond to specific treatments so the doctor can choose the best therapy the first time. This will also allow us to repurpose existing drugs in novel ways. Finally, while we are concentrating initially on better use of existing therapies, we also intend to collaborate with other research organizations to accelerate the discovery of new treatments.

Which health issues are you researching?

STEWART: Our first phase of research will examine five health problems where there are significant gaps in our ability to care for patients: multiple sclerosis, early detection of heart failure, Parkinson’s disease, chronic migraine and selected cancers. We are also looking at healthy aging to better understand factors that allow people to function well in older age. These areas also leverage existing expertise and research capabilities in the Sutter Health network.

What is a biobank?

STEWART: A biobank is analogous to a bank. You deposit and withdraw. In our first phase of work, the Sutter biobank will store biological samples such as blood and serum collected over time from 100,000 consenting patients with specific diseases of interest. We can withdraw samples on selected patients to answer questions that arise in our research efforts.

What are the advantages of a health system doing research?

TRANAH: In a health system, data accumulates naturally in the course of patient care. Sutter Health’s electronic health records contain long-term data on millions of ethnically and racially diverse patients that can be de-identified to protect patient confidentiality. So if I want to study multiple sclerosis, for example, I don’t have to recruit 5,000 study participants and follow them for 10 years. I already have the study population and health record data that includes their diagnoses, treatments and outcomes. If I collect blood samples from consenting patients, this dramatically compresses research time and cuts costs. If I collect serial blood samples from patients, the information this provides on biologic changes over time is invaluable. It’s a complete game-changer.

STEWART: Often it takes as many as 10 to 15 years for new discoveries to be put into practice. At Sutter Health, the data that we’re using for research is the data we use to deliver care. So our ability to take discoveries and translate them back into the care settings where we’re treating people is much more rapid and timely.

TRANAH: Because Sutter provides both primary and specialty care, we see patients just as a new disease is emerging. This is where the most important information comes from because we can track changes that occur at the molecular level. This information can then be used to determine who is likely to progress or respond to certain therapies early on, allowing us to develop individualized preventive or management plans.

This is very different from what happens in academic medical centers where this kind of research is typically conducted, but where the patients are more likely to seek care because they are in a later stage of disease that is not responding to treatments.

What about ethical concerns?

TRANAH: Ethics in research are always paramount. We are very thoughtful about the levels of consent and permission that we ask patients to give us. We want to make sure that people understand and consent to all of the different ways we might use their biologic samples and health information. All of our data is scrubbed to remove any personally-identifying information.

When will we see the benefits of Precision Medicine?

STEWART: It’s hard to answer such a question with certainty because our business is about exploring the unknown. But we’re hoping to begin having an impact in the next five years.