Government to test genetic info in ‘precision medicine’ initiative

The U.S. government’s plan to analyze genetic information from more than 1 million volunteers to understand human disease and develop targeted treatments was welcomed Friday by Southern Nevada medical researchers, providers and public health officials.

At the heart of the “precision medicine” initiative, announced Friday by President Barack Obama, is the creation of a pool of people — healthy and ill, men and women, old and young — who would be studied to learn how genetic variants affect health and disease. The president proposed $215 million in his 2016 budget for the initiative.

“Just from the standpoint of science and medicine, this is critically important,” said Dr. Mitchell Forman, dean of Touro University Nevada’s College of Osteopathic Medicine. “We are what’s in our genes. The applications of this are extraordinarily broad.”

The first benefits probably will be in the area of cancer treatment because oncologists have been developing the goal of personalized medicine for years.

“The goal is to know the complex biology of the specific cancer for the specific patient at the specific time,” said Dr. Fadi Braiteh, a medical oncologist with Comprehensive Cancer Centers of Nevada. “Two cancers can look the same but have a different biology, and two cancers can look very different but they can share the same biology.”

Braiteh echoes Obama’s promotion of the precision medicine initiative for “delivering the right treatments at the right time — every time — to the right person.”

Oncologists today have a much better understanding of the genetics of tumors to allow for a better match with treatments, said Dr. Nicholas Vogelzang, a medical oncologist and researcher at Comprehensive Cancer Centers of Nevada. Malignancies arise from a patient’s genetic code, growing in a unique body, targeting a unique immune system.

Finding medications and treatments to match the tumor can be laborious, time consuming and costly, Vogelzang said.

“We’ve learned that each cancer is very different. There are well over 200 different types,” Vogelzang said. “And probably every patient’s cancer is different.”

That’s why ocologists spend so much time detailing a patient’s history: medical, familial and personal, said Vogelsang, who appears Saturday at the Successful Aging Expo at the Cashman Center and Wednesday for NevBio’s World Cancer Day luncheon at Fogo de Chao. All those facets of someone’s physiology determine how the body is affected by disease and responds to treatment.

Forman and Dr. Mahboob Qureshi, a professor of immunology and microbiology at Touro, said genetic testing can benefit all areas of medicine. Some of the most practical applications could be in pregnancy planning and diet. Genetic markers, for example, could help identify certain foods that could cause problems for people with certain DNA information.

While the delivery of health care would realize most of the advantages from having a knowledge network of disease, public health officials also could benefit from the data, said Dr. Joe Iser, chief medical officer for the Southern Nevada Health District. For example, a specific genotype, or the inherited map within the genetic code, could be more susceptible to cancer caused by cigarettes or other toxins. Such evidence might be the basis of a public health strategy to prevent disease and promote health.

“That will give us a better way to target our efforts and our educational campaigns,” Iser said. “We don’t know what we don’t know, but that might give us a better way to target our interventions. That’s true for a variety of diseases.”

To achieve Obama’s initiative, U.S. officials hope genetic data from several hundred thousand participants in ongoing genetic studies would be used and other volunteers recruited to reach the 1 million total.

“Precision medicine gives us one of the greatest opportunities for new medical breakthroughs we’ve ever seen,” Obama said, promising that it would “lay a foundation for a new era of life-saving discoveries.”

Of the president proposed $215 million, $130 million would go to the National Institutes of Health to fund the research cohort and $70 million to NIH’s National Cancer Institute to intensify efforts to identify molecular drivers of cancer and apply that knowledge to drug development.

A further $10 million would go to the Food and Drug Administration to develop databases on which to build an appropriate regulatory structure; $5 million would go to the Office of the National Coordinator for Health Information Technology to develop privacy standards and ensure the secure exchange of data.

The funding is not nearly enough to sequence 1 million genomes from scratch. Whole-genome sequencing, though plummeting in price, still costs about $1,000 per genome, NIH Director Dr. Francis Collins said, meaning this component alone would cost $1 billion. Instead, he said, the national cohort would be assembled both from new volunteers interested in “an opportunity to take part in something historic,” and existing cohorts that are already linking genomic data to medical outcomes.

Another benefit to the president’s proposal might be that genetic testing becomes less expensive, Forman said.

“If a lot more people are working on it, the whole process might become more cost effective,” he said.

Reuters contributed to this report.