Faculty panel considers promises, challenges of precision health

At a Stanford Medicine Town Hall, three faculty members explored prospects for precision health — health care whose goal is to anticipate and prevent disease in the healthy and precisely diagnose and treat disease in the ill.

Lloyd Minor (far left) moderates a panel discussion on precision health featuring Mark Cullen, Mary Hawn and Mike Snyder at the Li Ka Shing Center for Learning and Knowledge.
Norbert von der Groeben

A population-health scientist, a surgeon and a geneticist discussed how clinicians could take advantage of large health data sets and advances in genomics during a panel discussion at an Oct. 12 Stanford Medicine Town Hall.

Moderated by Lloyd Minor, MD, dean of the School of Medicine, the discussion focused on the future of precision health — health care whose goal is to anticipate and prevent disease in the healthy and precisely diagnose and treat disease in the ill.

The town hall took place at the Li Ka Shing Center for Learning and Knowledge and was hosted by the dean; Amir Dan Rubin, president and CEO of Stanford Health Care; and Christopher Dawes, president and CEO of Stanford Children’s Health.

Panelist Mark Cullen, MD, professor of medicine and director of the Center for Population Health Sciences, said how and when clinicians are able to harness big data sets will depend on advances in computer engineering and data analytics. Cullen noted that the ability to collect and store information from individual human genomes, from electronic medical records and from portable health and activity trackers, such as Fitbits, is exploding. “It’s an extraordinary wealth of data about individuals, which can be rolled up and looked at across large populations,” he said. The challenge, he added, will be managing and analyzing that data so it can be brought to clinicians and patients.

Knowing your “omes”

Panelist Michael Snyder, PhD, professor and chair of genetics and director the Center for Genomics and Personalized Medicine, noted how cheap genomic sequencing has become. A person can get their whole genome sequenced for $1,400, he said. “The sequencing is no longer the barrier. It’s the cost of interpreting the results, which can run to $15,000. Sequencing is so cheap now you can bring it into the clinic. We see genomics having a huge impact in the area of cancer and rare diseases in kids. But how do we bring this to healthy persons?” One solution, he said, is to look not just at genomics, but also at proteomics, metabolomics, microbiomes and all the other “omics” that capture what we know about human biology.

Cullen, Hawn and Snyder answer questions during the Oct. 12 town hall.
Norbert von der Groeben

Snyder gave the following example: A woman has no history of breast cancer in her family, but she carries the BRCA gene variant, which is known to dramatically increase the risk of breast cancer and ovarian cancer. She is still healthy, but now that she knows her genetic information, she can take steps to reduce that risk. Knowing which gene variants a person carries is like an “orange alert,” he said.

We don’t yet have those massive data sets from genomics, electronic medical records and wearable devices, but the panelists agreed that the data is just around the corner. The big question is how to use modern analytics to present that data to clinicians at the bedside in a format they can actually use to help individual patients in real time. EMR data was designed to facilitate the transfer of information among different health-care providers, not as a research database, Cullen said. Finding ways to deploy EMR data in the clinic will depend on sophisticated analytics.

Mitigating risks

Mary Hawn, MD, professor and chair of surgery, discussed how precision health could help surgeons better understand their patients’ risk factors for surgery and mitigate those risks. “We know we aren’t going to get the same outcome from surgery for every single patient,” she said. Health-care providers have to know individual patients and what their individual risks might be. At the same time, providers need to be able to communicate that information to patients and their families, so they can make decisions that feel right to them. Ideally, Hawn said, “We can see what risks the patient is bringing to the table and mitigate those risks.” 

We can see what risks the patient is bringing to the table and mitigate those risks.

“We surgeons have been humbled by biology. We think we can do a great operation, but in the end, the biology wins,” Hawn said. “So, knowing that upfront, we can have a much more frank conversation with a patient about how invasive, how radical an operation to have if we can’t beat biology.”

Looking into the future, Cullen said that because studies of comparative effectiveness (comparing the relative effectiveness of competing medical interventions) are strong at Stanford, it’s a fruitful avenue of research. “If we do that well, we’ll align with national policies,” he added.

“Sometimes things take longer to happen than you think they should. Then they happen faster than you thought they could,” Minor said in concluding remarks, paraphrasing a famous quote by the economist Rudiger Dornbusch. “I think our challenge and our opportunity is to move from the category of things taking longer to happen than we think they should and into the category of making them happen faster than we thought they could.” 

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