Proponents say the marriage of health IT and individualized therapy will revolutionize health care. The jury is still out.
The teaser at the top of a recent Wall Street Journal article proclaimed, "What does the future of medicine hold? Tiny health monitors, tailored therapies--and the end of illness." Whoa! IT-enhanced personalized medical therapy holds great promise, but we won't be eliminating disease from the face of the earth any time soon. Nature is much too smart to let that happen.
And let's face it, it's nature we're battling: Microbes are crafty little devils that continue to find ways to resist the effects of antibiotics, and genetic mutations continue to put us in harm's way.
Despite these caveats, talk of individually tailored medical treatment isn't pie in the sky. This approach eventually will help us address risk factors even before a disease can invade our cells, and detect preclinical disease before it gets out of hand.
What role will medical informatics play in this brave new world? Dell, for one, is so convinced that health IT will have a major influence here that it's putting the infrastructure in place to support the use of electronic health records (EHRs) in genomics research. Dell recently donated $4 million worth of server capacity and services to support a project aimed at applying personalized medicine to pediatric cancer care.
[ Legally, EHRs are double-edged swords: They protect clinicians from malpractice litigation but also put them at greater risk. See
Will Your EHR Land You In Court? ]
The clinical trial project initially focuses on neuroblastoma, a rare, deadly cancer that strikes one in 100,000 children annually before the age 5 but is responsible for one in seven pediatric cancer deaths. Dell's cloud infrastructure, which will support collaboration and data exchange among oncologists and medical researchers nationwide will be placed at the Translational Genomics Research Institute (TGRI) , a key partner in the project.
Dell's donation is provided through its Powering the Possible philanthropic program. It will provide TGRI with 8.1 teraflop speed, PowerEdge Blade servers, Force10 network infrastructure, PowerVault storage arrays, and technical expertise to help with their gene sequencing.
Dell joins a growing number of IT vendors, including IBM, Informatica, and Cycle Computing, that are hoping to cash in on personalized medicine. Unfortunately, we've yet to see any strong evidence that this approach is actually improving clinical outcomes or reducing healthcare costs long term.
To be fair, much of the research being sponsored by these companies is still in its early stages, so we can't expect too much. Still, I wonder if the money wouldn't be better spent on more modest non-genetic initiatives.
At a recent symposium on personalized medicine, Ezekiel J. Emanuel, MD, chairman of the Department of Medical Ethics and Health at the University of Pennsylvania, questioned whether it would make more sense to target all the lifestyle mistakes that patients make rather than analyze genetic defects. His view: "Personalized medicine misses the most important fact about modern society--little ill health and premature death is genetic, much more is lifestyle and social."
Is Emanuel a dinosaur or a pragmatist? It's hard to say at this point. In recent years, advances in genetic medicine have improved individualized treatment for women with breast cancer. A woman's risk of developing breast cancer or ovarian cancer is greatly increased if she inherits a harmful BRCA1 or BRCA2 mutation, for instance. With that discovery in hand, scientists have developed a specific test to detect the mutations and a treatment that can be tailored to address those at high risk.
The only downside to this advance is that it benefits only a very small percentage of breast cancer patients. Emanuel's point is that investing in more-modest lifestyle-related initiatives will get us a bigger bang for the buck because they can be applied to a much larger patient population.
A case in point: When diabetic patients are given a computer-generated personalized report on their disease and goals for improving their long-term blood glucose levels, they're motivated to take action. Researchers have found a significant drop in these HbA1 levels, when compared to a group receiving traditional care.
In the final analysis, the future belongs to personalized medicine, and health IT will play an important role in making it a reality. What remains to be seen is whether it will come on the heels of big data projects such as the TGRI gene sequencing project, or "little data" initiatives such as the diabetes project mentioned above. There's no reason we can't do both.
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