Collaborative Culture: Russ Altman Discusses Personalized Medicine
Moving a great idea, such as personalized medicine that performs in concert with a patient’s genetic makeup, from concept to reality takes someone like Russ Altman, MD ’90, PhD ’89.
Altman is a walking endorsement for the benefits of a collaborative culture. He is chair of the bioengineering department, a professor of bioengineering, genetics, and medicine (and of computer science, by courtesy), director of the Biomedical Informatics Training Program, and a faculty member of Bio-X. Personalized medicine—which includes pharmacogenomics (the way in which human genetic background influences response to drugs), as well as the use of computer simulations to guide surgical decisions—unites his many interests.
One project Altman and collaborators are working on is dosing for the blood thinner warfarin. Because an overdose can cause spontaneous bleeding and an underdose can lead to clotting, proper dosing is particularly important. Since warfarin is prescribed to 2 million new users in the United States every year, safer dosing will have a big impact.
“Currently, we start with a low dose and have the patient return every week for small adjustments until we get just the right amount of anticoagulation,” Altman says. “With personalized dosing, we’ll take a DNA sample, check the genome for a few genes we know are important for determining response, plug that information into an equation, and get nearly the right dose from the start.”
Right Time, Right Place
Altman grew up in Queens, N.Y. A childhood fascination with science and technology, especially in the early days of computers, led to studying biochemistry and molecular biology at Harvard. He came to Stanford to pursue a doctorate in medical information sciences and to attend medical school, conducted a residency in internal medicine, and then applied for a faculty position “at the intersection of medical informatics and molecular biology,” he says.
Altman describes his work as “a dialogue between the engineer and the physician” in him. Stanford, he thinks, is the right place for that kind of collaboration. “Here, young faculty members aren’t in a pyramid system, where only some can succeed. Graduate students in most programs can work freely with faculty in any department,” he says, “and we’re all on one campus, so interactions are easy logistically.”
Collaborating Worldwide
Combining his medical expertise and his computer skills, Altman is also working on a project called Pharmacogenetics and Pharmacogenomics Knowledge Base (PharmGKB), a central repository for information and knowledge. “We had an opportunity to bring 21 groups working on warfarin together, which gave us a much bigger and more diverse sample of patients to study,” says Altman. “That collaboration involved four continents, nine countries, and 21 individual research groups. This is the kind of thing that can be done with the Internet, using Google groups to share documents and streamline the collaboration.”
Why is it important for science and engineering to collaborate? “Because most problems don’t obey departmental boundaries,” Altman says. “To have the right capabilities to solve problems, you need to bring together the best people from different fields. Engineers have known this forever, but other scientists learned it in only the last couple of decades.”