Kristin Newby: Precision medicine’s promise

Published 4:18 pm Tuesday, March 3, 2015

By Kristin Newby

Cardiologists generally prescribe four or five specific drugs to help heart attack patients avoid having another attack. I know because I prescribe them myself.

The drugs can be very effective and have helped save many lives, but it’s hard to predict exactly how they’ll work with specific patients. Sometimes patients take a drug and have a heart attack anyway. Sometimes they don’t take the drug and are fine. Sometimes a drug causes side effects in one patient but not in another.

In a recent speech at the White House — one largely overlooked amid the latest crises in the Middle East and other news — President Obama laid out a vision for a new kind of medicine in which we could identify more precisely which patients are most likely to benefit from a drug and least likely to have dangerous side effects. Each person’s treatment would be based on his or her specific genetic, clinical, social and environmental characteristics.

The president called this “precision medicine” and, for some of us on the front lines who confront disease routinely, it felt like the medical equivalent of President Kennedy’s vow to reach the moon within a decade. It’s an idea with the potential to transform medical care — not just for heart disease, but also for cancer, diabetes and many other conditions.

As things now stand, it typically takes decades and billions of dollars to bring a drug to market. Only one in 5,000 drugs makes it through this process, with many failing in clinical trials. Despite the tremendous progress we’ve made in biomedical science, the drug development process still relies heavily on trial and error, with researchers testing one compound after another to see which works. Precision medicine would improve these odds greatly by basing drugs on a deeper understanding of what exactly causes disease in a particular person.

It’s not a new concept, but recent advances in technology and medicine have moved it beyond the theoretical to the threshold of widespread application. Already we’re seeing powerful new kinds of treatments and therapies for cancer. The rest of us who treat patients in other fields would like to see similar and even faster progress.

The president’s $215 million initiative would help make that happen. It has high goals, including the creation of a large new research program in which a million or more people would confidentially share their medical information for the common good. Simultaneously, the National Cancer Institute would identify more genetic links to cancer.

I know this approach can work because I’ve been part of a research team that’s been doing something similar on a smaller but still impressive scale. Since 2007, our MURDOCK Study has gathered biological samples from 11,000 volunteers in North Carolina, using massive computing power to compare their genes, proteins, personal histories and other factors. The resulting analyses are beginning to help us understand both health and disease with much greater precision. We’re also learning about healthy aging and longevity.

More recently, some of us at Duke and Stanford universities have teamed up with Google to tackle the complex task of mapping the human body to better understand what a healthy person really looks like. Building on the original human genome project, which analyzed just a few people, we’re looking at many thousands, along with other variables. It’s a new kind of medical discovery, one that combines the powerful new techniques of “big data” with insights from emerging biomedical fields. It’s essentially the “precision medicine” the White House is backing, and we’re optimistic it can work.

I’m a medical researcher, not a politician, and I know we live in an era of political gridlock. However, this is one idea everyone can support. My colleagues and I have been heartened by the initial bipartisan support that both Congressional Republicans and business leaders have voiced for the president’s plan.

Personally, even though I am proud of the excellent care we now provide our patients, I am eager to take advantage of this historic opportunity to pursue a new level of personalized care that will save even more of their lives. Any American who anticipates getting sick in the future should want that, too. The president has proposed an ambitious, incredibly complex project, to be sure, but it’s one that both political leaders and ordinary Americans should embrace.

Dr. Kristin Newby is a cardiologist at the Duke Clinical Research Institute in Durham and principal investigator for the MURDOCK Study, based at the N.C. Research Campus in Kannapolis.