The concept of precision medicine is cresting the healthcare/technology convergence wave, and it’s been a hot topic of discussion this year. Recently, at two vastly different professional forums (one centered on health, one on technology), conversation around precision medicine provided the common denominator. Interestingly, the subject produces commentary and presentations from physicians who sound much like technologists, and from technology industry scions who sound much like medical theorists. It is evident that the potential of this cross-disciplinary field excites representatives from both spheres—even as it raises serious issues about practicality and scalability, it signifies unheralded opportunity.
At the Medical World Americas Conference and Expo 2016 in Houston, James Versalovic, M.D., Ph.D., head of the pathology department at Texas Children’s Hospital, spoke about personalized medicine and technology’s role in improving diagnosis in healthcare. He noted that digitalization is already guiding decision making, estimating that 70 percent of data in electronic health records (EHRs) are generated by pathology.
He went on to pinpoint the application of metagenomics in the gut microbiome to exemplify just one facet of precision medicine in development. His colleague, Baylor genetics professor Christine Eng, M.D., discussed how genomic data can be effectively used in a clinical context; for example, tracing multi-factorial origins and developing precise, genomic-based treatment of adult onset chronic disorders. At the same event, Mauro Ferrari, Ph.D., president and CEO of the Houston Methodist Research Institute, discussed his work in precision therapeutics and applying the principles of interdisciplinary collaboration to improve drug delivery at the molecular level. His study, recently published in Nature Biotechnology, demonstrates the use of engineered nanoparticles to elude biological barriers and deliver doxorubicin directly to the nucleus of cancerous cells: A transformational approach that holds great promise for breakthroughs in oncophysics.
Doug Given, M.D., Ph.D.
What is enabling this astonishing level of specificity in medical research and precision treatment? Speakers on the other side of the globe at an unrelated conference provided some insight.
At the IMEC Technology Forum 2016 in Brussels, the renowned nanoelectronics institute’s chief executive Luc Van den Hove discussed system technology co-optimization in what he called this “decennium of disruption,” which has produced an escalation in unforeseen innovation. He noted that this technological advancement will drive even more revolutionary changes in healthcare: “It will allow for real precision medicine, with a faster and more precise diagnosis and a finely tuned treatment.” He envisions medicine that recognizes every person’s genetic profile as unique, composed from the 6 billion characters in the human genome. Our current compute power enables rapid DNA sequencing, mass produced and at low cost: “We have developed a chip with electronics and photonics—on one chip—which will halve the cost of DNA sequencing.” By exploiting technology and integrating new capabilities for disease screening, diagnosis, and personalized therapy, we could see all three medical processes regularly achieved in the span of a day by 2020.
But moving from technological “capability” to precision medicine “reality” will require more than just the collection of big data. Van den Hove cautioned that we should strive to transmit wisdom, not data, via secure natural interactions in a network.
At the same event, Samsung president and chief strategy officer Young Sohn hinted at what that network could look like as he discussed combined sensor and algorithm development. Sohn showcased the 100+ developer network for the digital health device Simband, with data outpacing Moore’s Law. Echoing Van den Hove, he also envisioned 2020 as the target date for the solidification of a smart, connected, and open product cloud and ecosystem—with 100 percent digital appliances connected to address global challenges in health (increasing cost, aging population, and chronic disease) following an end-to-end IoT platform model.
But Georgia Papathomas, CIO at Johnson & Johnson Pharmaceuticals, touched upon the barriers to realizing these visions. The problem with all this data and interconnectivity lies in how to manage it, extract knowledge in real time and at scale, and pinpoint patient-centric value, all while ensuring privacy and transparency, and shepherding data ownership in flux. Healthcare and medical practice operate under more stringent constraints and must meet higher requirements than, say, streaming movies or delivering consumer goods. These are complex issues, and above all else, personalized/precision medicine must make it simpler for doctors and patients to manage their health.
Hans Hofstraat, vice president and innovation manager at Philips Research, also spoke at ITF in Brussels and he thinks that simplicity is an achievable goal, as the digital revolution will enable industrialization and personalization simultaneously. His group is leveraging its strengths in precision diagnostics and imaging to develop a cloud-based health and wellness platform focused on integrating information and providing mobile connectivity to move the point of care—delivering the right treatment at the right time, tailored to the patient.
But that is just one company working on its own to create a solution. How close are we to “real” precision medicine in real life? Right now, the patient typically encounters an expensive, one-size-fits-all, educated-guess-based, hospital-centric healthcare system. Streamlining technological adoption and integration must be a primary focus of collective, cross-industry efforts if we are to enable wide-scale application of personalized medicine. And as with Mauro Ferrari’s novel approach of leveraging advanced technological capabilities to more effectively deliver existing treatments (instead of the traditional focus on developing “new” treatments), we should reexamine all our assumptions about what is necessary and what is possible.
Precision medicine is a big concept that inherently inspires equally big concepts.
To wit, another impressive speaker at ITF equated innovation with an even larger purpose. Peter Piot, M.D., Ph.D., Ebola co-discoverer and director of the London School of Hygiene and Tropical Medicine, spoke of the need to leverage the current interest in precision medicine to global health, population health and diseases prevention. Precision medicine, by his account, espouses using technology, genomics, and big data to result in an outcome for the individual. “Precision global health” extends that model to include whole populations resulting in outcomes for communities.
Doug Given, M.D., Ph.D., is CEO of Health2047, an American Medical Association (AMA)-funded integrated innovation company based in San Francisco that is focused on improving healthcare at a system level. Additionally, he serves as chairman of the board at both Arrowhead Research and Vivaldi Biosciences, and is a managing partner at G5 Partners, a Silicon Valley strategic advisory and venture investment firm.