Capitol Hill Briefing to Explain the Value of Personalized Medicine

Back in February this blog reported on the story of Adriana Jenkins, a breast cancer patient who, shortly before her death, called for policies to accelerate personalized medicine:

“A targeted cancer drug kept me alive for nine years. Congress must ensure that future patients get the same chance to live.”

PMC has been working hard to respond to Adriana’s call for action. As one step in this, we’re pleased to be taking part in a briefing on Capitol Hill describing the status of personalized medicine and potential steps to accelerate it.

Advancing personalized medicine involves the complex process of bringing together the many stakeholders who have a role in the health care ecosystem: pharmaceutical companies, diagnostics companies, clinical laboratories, health information technology companies, health care providers, payors, and researchers.  Each comes to personalized medicine with a different perspective but a common goal – improving treatment for patients like Adriana through personalized medicine.

As Adriana pointed out, policymakers play a key role in advancing personalized medicine.  Health care reform raised the profile of the term on Capitol Hill but several members of Congress and congressional staffers have told me that they and their colleagues want to better understand how personalized medicine can improve health outcomes, lower health care costs, and ultimately improve patient care. Today we will take an important step in raising awareness and understanding of personalized medicine on Capitol Hill.

Working with the House Medical Technology Caucus co-chairs Rep. Erik Paulsen (R-Minn.) and Rep. Anna Eshoo (D-Calif.), the Personalized Medicine Coalition is hosting a briefing on Capitol Hill to inform members of Congress and congressional staff about personalized medicine and how public policy can further its development through incentives, regulatory changes, and HIT-enabled opportunities.

At the briefing we will hear from researchers, providers and patient advocates.  Joining us will be Stephen Eck, M.D., Ph.D., Vice President and Global Head of Medical Oncology for Astellas Pharma Global Development, Amy Abernethy, M.D., Director of the Duke Cancer Care Research Program at Duke Cancer Institute, and Donna Cryer, J.D., CEO of CryerHealth and Chair of the American Liver Foundation’s Board of Directors.

The briefing will take place today in the Rayburn House Office Building Room B-338 on Capitol Hill from noon-1 pm.  Limited seating is available; please register here (http://events.constantcontact.com/register/event?llr=g8sac8dab&oeidk=a07e3mmnzg5cc593a37) or email Tswope@personalizedmedicinecoalition.org.

CER and Personalized Medicine: More Work to Be Done

I just got back from a meeting of the Board of Governors of the Patient-Centered Outcomes Research Institute in New York City. PCORI, as you probably know, is the independent Institute established by the health reform law to conduct comparative clinical effectiveness research. Regarding CER and personalized medicine, I’ll say now what I said late in late 2009: in the midst of the debate over health care reform — it remains to be seen whether CER will align with personalized medicine. CER that aligns with personalized medicine should be  patient-centered, because it will be structured to recognize and respect patient differences. 

We’ve made important progress toward that goal, with CER statute for the first time referencing genetics and individual patient difference.  I am hopeful we’ll  eventually get there, but we’re not there yet. Personalized medicine was, as far as I saw, mentioned only once during the PCORI Board meeting. NIH Director Francis Collins raised it during a discussion of the report from the PCORI Methodology Committee. Commenting on the Committee’s charter and the “perceived tension between CER and personalized medicine,” he said he “would hope that the Methodology Committee would take that on,” and suggested emphasizing alignment with personalized medicine and patient preferences in the document. I applaud Dr. Collins for raising this point, but we will need more voices joining him to make sure the Board and Methodology Committee to integrate CER and PM. It seems to reinforce some concerns expressed earlier by PMC about lack of an expert in genomics or personalized medicine on the Methodology Committee. The idea proposed by PMC of creating an advisory panel on personalized medicine and innovation could be one step to help ensure alignment between CER and personalized medicine.
   
One of the big news items from the PCORI Board meeting was the appointment of Dr. Joe Selby as the PCORI Executive Director. I was heartened by Dr. Selby’s comments at the meeting, in which he stressed the importance of hearing from, and focusing on, patients. It will be equally important for Dr. Selby and the additional staff he hires to understand that part of the Institute’s charge from Congress is to account for genomics and subpopulation differences. Failure to do so will prevent us from realizing the potential for personalized medicine to improve health care quality and value. 

The next meeting of the PCORI Board of Governors is in Washington, D.C. on July 18 and 19th. I hope you’ll join me there in support of comparative clinical effectiveness research that is centered on patient needs and aligned with personalized medicine.

Advancing Personalized Medicine from Theory to Practice

When your genomic information informs your increased risk for coronary artery disease, and you make lifestyle changes to reduce your risk, personalized medicine has revealed itself. If you have a gene variation that influences how you metabolize a blood thinner, and your physician prescribes dosing instructions accordingly, the practice of medicine is now safer, well-timed, accurate, and cost-effective for you and our healthcare system. Challenges do remain: Evidence-based research establishing the utility of personalized medicine in the clinic is lacking; essential training in genetics and genomics must still be incorporated into medical school education; and the integration of genomic data into electronic medical records and routine clinical care is needed.

Advances in technology and decreases in cost mean a considerable quantity of genetic data is being generated. However, in order for these advances to have a broader impact, physicians and their patients must first ascend the learning curve associated with actually employing genetic data in clinical decision-making and then stay on top of new understandings of the molecular basis for disease. The true practice of personalized medicine will only be realized when we can rapidly translate the molecular information we uncover into behavior change and/or medical care.

This is the goal of the Coriell Personalized Medicine Collaborative® (CPMC®),  a forward-looking research study involving volunteer study participants, physicians, scientists, ethicists, genetic counselors, pharmacists, and IT experts seeking to determine the usefulness of personal genome information in health management.

How it works:  Study participants submit a saliva sample for genome analysis and answer online health questionnaires about lifestyle, medical and family histories. In return, participants receive personalized risk assessments for potentially actionable health conditions, and for responses to commonly prescribed medications. Participants are asked to complete periodic follow-up surveys to determine whether receipt of this information influenced their personal health decisions.

The CPMC research study only reports on conditions deemed “potentially actionable” – where risk can be reduced by individual action (behavior or lifestyle) or by medical action (screening, preventive treatment, or early intervention). To determine which conditions are “potentially actionable” and thus returned to study participants, the CPMC research study engages two independent, expert advisory boards which convene twice a year to advise on the actionability of conditions and vote to release them. In this way, the CPMC is helping to integrate the latest advances in personalized medicine from the research bench into clinical care.

Some may call this a conservative approach; Coriell believes that by being measured in our return of genomic information today, and coupling it with education and assistance, we are preparing physicians and patients for a near future when they will have access to the incredible amount of genome information available.

What study participants receive:  Currently reported actionable health conditions include coronary artery disease, lupus, melanoma, age-related macular degeneration, prostate cancer, iron overload, and types 1 and 2 diabetes. Risk reports for medication response are also provided; at this time, personalized reports indicating how participants will respond to Plavix^®, a commonly used drug for the prevention of blood clots, are available. To help with the interpretation of genomic information, research study participants and their physician(s) have zero-cost access to CPMC genetic counselors and pharmacists. 

Who is participating:  The CPMC has more than 5,000 participants already enrolled, and another 2,000 are joining through a partnership with Ohio State University Medical Center.

Looking forward:  The CPMC study is positioned to significantly contribute to comparative effectiveness research that, when appropriately designed, can accelerate the intelligent adoption of personalized medicine. As the community committed to the advancement of personalized medicine continues to grow, the CPMC research study aims to serve as a model for the ethical, legal and responsible implementation of best practices for genome-informed personalized medicine.

Study Finds Physicians Eager to Learn More about Molecular Diagnostics

Molecular diagnostics are a critical driver of personalized medicine, but what does the ultimate end user—the physician—really think about the potential and application of these tests in everyday clinical practice? Such insight could prove valuable for marketing and sales executives seeking to understand the barriers and catalysts for adoption of personalized medicine products and services by these critical customers.

CAHG, a health care communications company, conducted a study of physicians’ awareness, attitudes, and adoption of genomics, molecular diagnostics, and targeted therapies. Results of the study, which included oncologists, cardiologists, and primary care physicians, suggest that this critical set of health care gatekeepers has a low level of knowledge of personalized medicine in general and molecular diagnostics in particular. Only eight percent of doctors are very familiar with the current issues and advances in personalized medicine, and 50 percent have received no education at all on the topic.

Although oncologists generally reported more experience and familiarity with molecular diagnostics, primary care physicians, and to a lesser extent cardiologists, lack confidence with all aspects of molecular diagnostics, from identifying appropriate patients for testing, choosing the right test, understanding and interpreting the results, and even explaining test results to their patients. Moreover, all three specialties, oncologists included, have low confidence with the basic logistics of testing such as choosing which lab to send a test to, determining if a test is covered by insurance, and identifying the right insurance codes.

This lack of knowledge and confidence, however, creates opportunities for industry. The study found that an overwhelming majority of physicians – nine in 10 – are interested in learning more about personalized medicine as it relates to their practice. Of particular note is their willingness to meet with pharmaceutical and molecular diagnostic company sales representatives to learn more about targeted therapies and molecular diagnostic tests.

This eagerness for knowledge underscores the need for the medical community—including industry—to provide educational programs and informational materials to prepare physicians for the inevitable influx of new personalized medicine products, including molecular diagnostic tests. Such initiatives will help accelerate the adoption of personalized medicine from promise into practice.

You can learn more about this study in the spring edition of the PMC newsletter at http://www.personalizedmedicinecoalition.org/sites/default/files/files/PMC_Spring%20’11.pdf.