The state of precision medicine: Star Wars tech on a Flintstones chassis

The ability to sequence the human genome to predict chronic diseases is the Star Wars part but the infrastructure to support personalized care is still in the Flintstones age.
By Susan Morse
11:58 AM
state of precision medicine

If precision medicine is the future and this type of care is all about the individual, then the healthcare industry needs to become nimble like an Amazon to compete against other businesses that are frankly better at zooming in on consumers’ needs.

“If I bought books on Amazon two years ago, they still know what I like and need,” said Pfizer CMO Freda Lewis-Hall, MD. “I think Amazon is around changing the dynamic. We are still in a system delivering Star Wars advancement in technology in a Flintstones’ healthcare system.”

The ability to sequence the human genome to predict adverse health events and the onset of chronic diseases, that’s the Star Wars part. Meet the Flintstones: Today’s existing technological infrastructure to support personalized care and all the data it will demand is not nearly robust enough.

[Also: AMA calls for clarity on how precision medicine is reimbursed]

But forward-looking hospital executives are eagerly tracking the billions of dollars investors are pumping into emerging technologies and research to advance precision medicine so they can better understand what’s coming in the not-so-distant future and where it might make the most sense to invest their own budgets.

Big opportunities: Alzheimer’s, Cancer

Medical knowledge is growing faster than what healthcare experts can practically do with the information.

“The speed of knowledge is accelerating,” said Cleveland Clinic CEO Toby Cosgrove. “I’m always stunned by the data that has been accumulated. By 2020, knowledge will be doubling every 73 days.”

In lockstep with growing mountains of data, disease states where personalized regimens can have a big impact are coming into focus, Alzheimer’s and cancer among those.

Microsoft Founder Bill Gates just this week announced that he will personally invest $50 million into the Dementia Discovery Fund, a venture capital collaboration of charity, industry and government groups focused on finding treatments for the disease. The Dementia Discover Fund explores “less mainstream approaches to treating dementia,” Gates said.

Alzheimer’s is projected to affect one in three Americans by the time they reach the age 80, according to Neurotrack founder and CEO Ellie Kaplan.

Kaplan, whose company uses eye-tracking technology to predict Alzheimer’s decades before it’s medically diagnosed, called the disease “the greatest healthcare challenge of our generation.”

Caught early, the onset of Alzheimer’s cognitive decline can be delayed, according to Kaplan. This would be a lifeline to patients and families affected by the disease, and could make the difference between saving millions of dollars in healthcare costs. 

Cancer is also on the front line for precision medicine’s genome therapy.

The drug spend for oncology is growing by 18 percent, said Chris Cournoyer, CEO, N-of-One. Reimbursement becomes an issue.

“If you look at the drug pipeline, 87 percent are biomarker-driven,” Cournoyer said. “What that tells me in the next five years we’ll see a lot more targeted therapies.”

VC money is there

Investors will pour some $2.8 billion into precision medicine companies this year alone, according to GE Ventures CEO Sue Siegel.

Emma Cartmell, CEO and founding partner of Cartmell Venture Capital, whose clients include Morgan Stanley, said investors are looking to put their money into companies that are part of a larger ecosystem.

“The companies that are really making a difference are the ones that are pragmatic,” said Alexander Grunewald, global head of HealthTech Investment Strategy for Johnson & Johnson.

[Also: New precision medicine tools mean CIOs have to push them into the clinical workflow]

With big opportunities to personalize treatment — and historically disruptive companies eyeing healthcare — hospitals and networks are going to have to be pragmatic. too.  

Where genomic sequencing stands today

“We are at the tipping point of genomics, personalized therapies ... 42 percent of drugs in the pipeline have the potential to personalize therapies.” Stephen Ubl, CEO of PhRMA said.

Ten percent of all disease is due to a strong, predisposition gene, said Charis Eng, MD, PhD, founding chair, Genomic Medicine Institute, Cleveland Clinic. Once identified, the industry could stratify risk.

“The opportunities for personalized medicine are extraordinary,” said Alexander Ford, president Myriad Genetic Laboratories. “We have profound advances in understanding how the human genome functions … I think the potential is enormous. We’ll learn more about the cause of disease and bring new treatments forward. It will take a decade to see the real promise of genomics.”

Researchers already have three decades of genomics in the rearview mirror, said Eric Green, MD, director of the NIH National Human Genome Research Institute. The Human Genome Project took place between 1990 and 2013.

Despite this, said Cindy Collins, CEO of Human Longevity, “We understand less than 5 percent of what the human genome really means.”

Inhibiting progress

What’s stopping forward movement is getting the research into practical use in hospitals and the hands of physicians.

Green of the NIH said right now about 20 percent of all genome sequencing is being done by routine healthcare. In the future, this will be 80 percent, he said.

Coming into play are the environmental, social, hereditary and other factors that turn all talk of the finer brush of precision medicine into the broader stroke of population health.

“We have large amounts of data,” said Brian Bolwell, MD, chair of the Taussig Cancer Institute of the Cleveland Clinic. “The problem is making it actionable.”

Interoperability is one challenge. The pricing and timing of drug therapies, and recruiting enough patients for clinical trials, are others. As is the fact that fewer than 5 percent of patients are enrolled in clinical trials.

“I still have to wait months if not years,” Lewis-Hall said of the time it takes for new drugs to come to market. “From the aha moment to when it’s applied to patients, I still have to wait a generation.”

Indeed, with increasing competition within and from outside healthcare, hospitals are going to have to accelerate that pace in lockstep with equipping clinicians with the most timely and actionable research and information.

Staying ahead of Amazon, CVS and WalMart

Healthcare must look over its shoulder to keep up with the competition that appears to be brewing among Amazon, Apple, CVS, Walmart and others.

That will mean modernizing IT infrastructure to prepare for precision medicine programs around Alzheimer’s, cancer and other common diseases and chronic conditions in ways that you can reap the large-scale investments those programs will require.  

Just don’t get overly enamored with technology, cautioned J&J’s Alexander Grunewald.

Cleveland Clinic’s Cosgrove added that advancing precision medicine research, technology and information will require a lot of voices.

“Without significant consolidation on the part of providers, it’s going to put us at a disadvantage,” Cosgrove said. “Fifty-five percent of hospitals in the U.S. lose money on patient care. We move on a very small margin. We are concerned about major forces, Amazon, coming at us in purchasing.” 

Fending off those threats will ultimately be a matter of evolving out of a Flintstones era for the sake of survival. 

Twitter: @SusanJMorse
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