Jeffrey Alan Golden, MD
What we’re defining as precision medicine here at the Brigham and Women's Hospital is taking everything that encompasses what that patient is about and applying it to understand that individual.
We'll use imaging data. We'll use clinical phenotyping, how you present, what your clinical features are. We'll use pharmacologic data. In other words, how you've responded personally to certain medications you've had to take. We'll use other laboratory data, chemistry data and hematologic data. We'll use genomic data. We'll also use proteomic data, in other words, how proteins fold and function. We'll use metabolic data, how your body is interacting and producing energy.
We’re going to put all of that information together. We’re going to build algorithms using things like machine learning, using natural language processing to comb the medical literature and comb the clinical data bases. We’re going to take all of that and build algorithms that are going to allow us to predict what’s going to happen with groups of patients and then eventually drill down to what should be done for individual patients.
In collaboration with the Dana-Farber Cancer Institute, we have been making a number of efforts around cancer. The goal is to look at the cancer genome. Cancer's actually a genetic disease in almost all cases. What we need to do is understand what the genetic changes are, the drivers of that cancer, as well as the things that permit it to continue to grow and how they're distinguished from that patient's genome. We're building those algorithms that I was discussing to understand the best way to care for patients that have cancer.
A recent study showed that by implementing this type of precision medicine you can actually reduce the cost of care. You reduce the number of hospitalizations for patients, you reduce the number of times they go to the emergency room and you significantly increase their lifespan and the quality of their lives.
In the pulmonary domain, what we're doing for pulmonary medicine, has been focused on understanding these very recalcitrant to treatment disorders in interstitial fibrosis and cystic lung disease. Again, by understanding the genome, but also the metabolome, and pulmonary function tests, and integrating the radiology, we're stratifying patients. Treatment is going to be based on that stratification.
A really interesting project we’re doing right now is looking at the microbiome. This is all the bacteria you have in your gut. We’re actually developing algorithms, right now here at the Brigham and Women’s Hospital, that will allow us to predict which patients are going to develop one of the most common causes of hospital-acquired infections, Clostridium difficile, which causes a severe diarrhea. It actually causes a lot of morbidity and mortality in this country, about $1.4 billion a year. We expect we’re going to be able to predict not only which patients, but by using this type of precision medicine approach, we’re going to actually be able to come up with a way to prevent it in all of those patients.
What I would like to see for precision medicine is to become how we care for all patients in this hospital, that we develop the computational skill sets to take this massive amount of data that we generate on all our patients here and use it in an effective way to anticipate and prevent disease. That’s the ultimate goal. Provide better care, better outcomes and at a lower cost. That’s where I think precision medicine’s going to have an impact in health care.
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