Charlie Rose

davidsmith11147  08/17/2009 11:42 PM Report

We need to move forward, not backwards. These technology leaders are helping us do this. I am so excited to see what is going to happen in this field.

ion  07/10/2009 07:41 PM Report

I remember the first time I heard the 'personalized medicine' meme from an administrator at a prominent research hospital and thought 'how silly', but it seems to have stuck now. I've heard language referred to as a virus, and so it is...

But really this technology is all about better disease diagnostics and treatment protocols, as medicine has mostly always been. Blood letting used to be prescribed for all sorts of maladies, and it still is appropriate for certain conditions (e.g. Hemochromatosis ), so one could argue we are continuing to 'personalize medicine'. To further complicate matters I may have a "gene variant" that is problematic, but it could be completely silenced in the cell of interest or perhaps compensated for by increased/decreased expression of another gene, etc. etc. - so the spatial/temporal components of biological activity (e.g. expression activity, and proteomics/metabolomics) will always be more interesting and valuable as a clinical tool

>prevention is an almost completely neglected element of health today, so I am not sure that knowing something about genetic predispositions is going to make much difference

This depends on the healthcare system one finds themselves in. In the US, the incentive structure is certainly not optimal for preventative care though. Genetic pre disposition coupled with environment is one aspect of disease, but the more exciting element of what is developing is the quantification of the temporal/spatial aspects of a disease state. I don't mean to imply that Agus and Church are not aware of this, since their labs are very active in this aspect of research (gene expression, proteomics/metabolomics or the state space of plasma, and more importantly the synthesis of this information in to causal networks), it's just it was not explained as well to the viewer.

>how do you keep that information from adversely impacting you by becoming available to your insurance company, employer, or someone else

I argue you don't, all the more reason to bring some sanity to the way our current healthcare system is structured. to roughly quote: "Personal Computers? Who would want one of those?"

What a brave new world we are entering

>What happened to ‘treat the patient, not the disease’?

I don't believe this is being neglected (yet) with these new technologies. I've seen Agus in a clinical setting, and I would argue that one of his strengths is as a physician that is capable of relating to his patients.

>Re: JGoldsmith's comments

There are tests to determine appropriate drug levels, e.g. Warfarin - however, you are correct that they are not as prevalent as they likely will be in the future. The bigger question (you raise) of quantifying drug or treatment protocol efficacy based on outcome studies needs much more than new tests, but a change in the way healthcare data is managed. One aspect of the problem was briefly mentioned in the discussion, in regard to the mess of terminology structures currently in use (e.g. SNOMED, etc.). This is more a sociological problem than a technical one, as are many of the problems in computer science, but there are big legislative difficulties now too with the introduction of HIPAA rules, etc.. In the US, the best databases are usually maintained by the Health Insurers and this data is difficult to access - outside the US, the 'socialized' health entities are way ahead for collecting good data but they too are still far from an optimal state. There are many logical questions one could ask about prescription drugs, such as: Why not make all of the raw data for a drug available to the public? I understand not everyone is well read in statistics, but to imply only drug or device company representatives are capable of distilling the information to physicians in a meaningful way, is ludicrous.

>They are forgetting the mind/body connection. It was hinted at when one of these doctors mentioned "more love" to lessen heart disease.

I don't think any of the people on the panel discount this aspect of health. However, this is one component of many that comprise a 'healthy' body, and it was not the focus of the discussions. The link between mental state (stress, etc.) and e.g. immune state is one of many well known 'mind/body' links - the immune system is constantly cleaning up potential 'cancers' and other problematic entities.

Janis Derrick  09/01/2008 07:39 PM Report

They are forgetting the mind/body connection. It was hinted at when one of these doctors mentioned "more love" to lessen heart disease.

The emotional part of disease maybe the first step in developing a disease.

Neil MacCallister  08/04/2008 03:23 AM Report

As Francis Collins reveals in the related interview, the only thing to fear from Personal Genetics is the knowledge of ourselves. I'll bet the work of Mr. Agus' Navigenics (and others) will spread exponentially until our individual DNA markers are as familiar to each of us as our telephone number. And don't fear "the insurance companies", ..they can already prognose my outcome quite closely by my DOB, school and driving record, and store-purchase history. Perhaps Mr. Ornish or Mr. Church will learn how to turn back on the genes for essential vitamins, or tell me which vegetables best suit my personal anabolic needs. Will my personal hormonal, neurotransmitter, transcription factor pattern guide me in the choice of professional career? (..Would I be happier as a Carpenter or Lab Tech?) I'd actually like to know! Can embryonic stem cells be better controlled, sustained, and reproduced (Providing help to millions, at both tables in that debate.) Should I go 'low carb', 'low fat', or 'low Cal'? So many of us seek "who we are", ..here's a roadmap to our individuality!

JGoldsmith  08/01/2008 11:24 PM Report

We would never dream of giving a unit of blood without checking blood type and group--protein markers of a person's genome. Yet we continue to give drugs to people that can't use them, or who will overdose at "normal" dosages. More than half the drugs prescribed in the US (more than 100 billion dollars worth every year) do not have the intended therapeutic effect for the patient. Have prostate cancer? The surgeon insists that surgery is the right option, the radiologist will recommend radaition therapy, the ocnoclogist may recommend hormonal therapy and anther doctor says 'Watchful waiting". Won't if be nice to have some data to say which course to follow instead of guessing and hoping you're not the one in ten that needs immediate treatment?

Juan Manuel Schvartzman  08/01/2008 09:48 PM Report

This interesting discussion by 3 prominent advocates of ‘taylored care’ who champion genome wide association studies and SNP array diagnostic companies as the forebringers of the Star Trek Health System leaves an important issue undiscussed. With all do sincerity, aren’t we forgetting that intelligent medicine, and hence intelligent physicians, have always practiced personalized care? What happened to ‘treat the patient, not the disease’? The skill of choosing which one of therapies A, B, C, D, or E will most likely benefit Mr or Mrs Smith who in addition to XYZ, also suffers from M, N, O and P is in and of itself personalized medicine. And it is a skill, one that can be taught and improved; not, like many would like to argue (but no time for this now), an art. Just ask a painter whether he’d like that sort of creativity applied to choice of chemotherapy. So when all these new, shiny, wonderful diagnostic techniques and targeted therapies are being advertised as the ‘internet’ or ‘cell phones’ of the modern medical age, let’s just remember that the situation hasn’t changed: caring doctors will still have to manage scared patients with the, now slightly expanded, sets of tools in their bag. Even if stethoscopes now come with SNP-array readers.

Amy at Navigenics  08/01/2008 05:28 PM Report

To follow up on the comment below from plasmapal, here is an update on GINA, a powerful new law that limits the use of genetic information by health insurers and employers:

http://blog.navigenics.com/articles/comments/new_genetic_anti_discrimination_law_helps_even_ahead_of_ time1/

Henry Cisten  07/30/2008 04:50 PM Report

I was very surprised that after this show my opinion on consumer genetic testing has changed. i want to be in charge of my health. excellent show. we need more doctors like agus who put patients first.

Alex Hargrove  07/30/2008 11:12 AM Report

excellent segment about a very important topic. healthcare needs to be changed, and the emphasis needs to be on prevention- this technology is the first major step in prevention I have seen in 10 years. bravo to the scientists and docs on the show.

sock puppet  07/30/2008 01:16 AM Report

Given egregioue greed ala subprime loans, the financial wise-guys will doubtless manipulate and monopolize these genome capabilities into exploitable commodities leveraging them out of reach for the peasant class. The elite will capitalize this into a delusional master race of inbred effete fools. Wallstreet on Viagra.

plasmapal  07/30/2008 01:13 AM Report

Fascinating, truly masterful presentation.

I was glad to see you finally got around to asking what I first thought to myself when the full implication of the possible applications of this technology occurred to me, namely how do you keep that information from adversely impacting you by becoming available to your insurance company, employer, or someone else.

The response detailed current proposed legislation to prevent privacy invasions, and I'm willing to believe my fellow citizens would insist on these protections.

The thing is, I believe more and more of my fellow citizens believe that they are somehow entitled to "free" health care, even though most of us recognize our responsibility for our cell phone bill. Of course they cut you off if you don't pay.

The point is, if the federal government becomes responsible for our health care, I do not believe they will refrain from accessing this information eventually. Once the information is in a database it becomes vulnerable, period. Since the government has sponsored much of this research and will most likely underwrite a significant portion of future research in some manner, it stands to reason that the federal government will retain some ownership of this data for as long as it exists.

Considering the extent of the information and its implications, this is potentially far more dangerous in benevolent government hands in bulk than in the possession of any nefarious element on an individual basis.

renatam  07/30/2008 01:00 AM Report

Electing a literate, pro-Science President -- whose wife is a REAL healthcare professional executive on the front lines of our reactive and expensive system -- will put America on a solid path to continue to pioneer and exploit these new technologies. A President who is also a Constitutional scholar -- and an African-American -- will prioritize putting laws and safeguards in place to prevent abuses, assure privacy and ensure access to ALL Americans -- not just the privileged few. These technologies are too important in the war against Cancer, and must be an integral part of a new consumer healthcare paradigm that is based upon PREVENTION and MANAGEMENT.

RE Mant  07/30/2008 12:30 AM Report

Looking backwards it is easy to see that the sanitation crusades of the 19th c had far more effect on prevention than any subsequent treatment of disease, but, nevertheless, prevention is an almost completely neglected element of health today, so I am not sure that knowing something about genetic predispositions is going to make much difference. We haven't done much about global warming, many pollutants, smoking, transfats, high fructose corn syrup, balanced diet, and a thousand other things we know about, not to mention our monetary system, which alone probably accounts for more ill-health than everything combined. A considerable portion of the population and a few major religions don't even believe in human agency, anymore than they believed in education a 150 years ago. Then too, there is a considerable danger of the Social Darwinist abuse of this data effecting precisely the opposite of what is intended.