Expert Panel: Next Steps to Achieving Precision Medicine
By Allison Proffitt
February 24, 2022 | In the opening plenary panel for the Molecular and Precision Med Tri-Con this week, Robert Green, Brigham and Women’s Hospital, led a group in exploring how genomics, digital health, and more will converge to deliver precision health.
He was joined by Megan Mahoney, Stanford University; Jessica Mega, Verily Life Sciences; Sir Mark Caulfield, Barts Life Sciences & Queen Mary University of London; and Lara Jehi, Cleveland Clinic.
With representatives from government, academia, and industry, Green asked the panel which parts of the precision health puzzle should belong to which sector. The panel agreed that close relationships between the three are key to innovation, care delivery, and trialing new solutions.
Megan Mahoney, Stanford University, pointed out that the rapid cycle of innovation in industry makes for good partnerships for academic labs. Jessica Mega, Verily Life Sciences, agreed that industry brings a lot of tools to speed the innovation cycle as well as sometimes unique bandwidth to manage extremely high data volumes. For instance, she highlighted the role of sensors and tools in the future to gather health and lifestyle data all the of time—beyond just office visits.
Sir Mark Caulfield, Barts Life Sciences & Queen Mary University of London, reflected on his time at Genomics England, and highlighted the unique role governments have in catalyzing industry growth with investments. Governments can stimulate markets, which in turn stimulates innovation, he said. Though he admitted that Genomics England over-estimated the maturity of the market when it launched. They expected to have more partners available with scalable solutions, but in fact most solutions couldn’t scale to the population level yet. The government investment, though, prompted increased effort from many private groups to meet the need.
He also warned against some risks of public-private partnerships, namely rushing private solutions into use before they are fully validated. The healthcare system needs to see and understand the evidence for a new treatment or approach and then decide to change care based on that data, he said.
Mahoney highlighted the importance of making sure our efforts toward precision medicine are equitable and available to the entire population. This is not only the right thing to do, she said, but in the United States, demographics are changing. We need to deliver care that reflects the population’s diversity.
Building Buy In
She advocated for considering goals—feasibility, accessibility, and uptake—at the earliest stages of design, incorporating diverse voices so that the products and tools we design are acceptable and relevant. For example, among groups who have historically been slow up adopt digital health tools—the elderly, rural communities, some minorities—Stanford found that adoption barriers could be overcome with extra effort including additional support staff or engaging a caregiver. We found this to be really achievable and exciting, she said.
Green was, perhaps, less optimistic. In an earlier talk he reported his findings with the first iteration of BabySeq, the newborn sequencing program he championed at Brigham and Women’s Hospital and Boston Children’s Hospital. The majority of parents in the newborn ward declined whole exome sequencing for their newborns, even though a previous survey had suggested that more than half of parents were interested in the idea. The first BabySeq project approached more than 3400 families and ended up sequencing 159.
“It’s very interesting insight there about what people say when they are globally interested in this, versus what it means to tell them about low probability but very negative events that could come accompany the presentation of such a service,” he said.
But others on the panel seemed to share Mahoney’s optimism. Lara Jehi, Cleveland Clinic, reported their experience gaining consent for biospecimen research. The Clinic invited patients to review consent documents and other materials to make sure they are accessible as well as accurate. It’s working, she said. Enrollment is increasing for previously under-represented groups.
Caulfield agreed that trust is paramount and cautioned that it is exceedingly hard to earn back once lost. He suggested not only involving patients early on when developing new tools or precision medicine programs, but also front-line medical workers, the individuals who will eventually implement and use these programs. Get the front-line workers involved in shaping the program, and they’ll clamor for adoption once it’s completed, he said. Those workers are your adoption plan.
By way of closing, Green asked the panel to cast visions of what precision medicine may look like in five, 10, or 50 years.
Green began, looking forward to accessible and inexpensive sequencing for every baby with risk stratification data that can follow the child through life. BabySeq2 received funding in August 2021 and will be a continuation of the first study with a focus on serving under-represented minorities.
Mahoney believes that precision health can enable health equity and serve diverse populations. She highlighted partnerships as key to achieving that goal.
Jehi wants a more efficient cycle of innovation and discovery, more quickly bringing an idea through the research phase, clinical development, and then deployment. We’ve been gathering a lot of information in service of this goal, she said, and she’s hopeful that our data overload will soon shift into applicable knowledge.
Mega also highlighted the role partnerships will play in precision health of the future. It will take all of us, she said, to achieve our grand goals.
Finally, Green also gave voice to a vision that many of the panelists echoed: a shift in the healthcare system from treatment to prevention, managing illness to maintaining health. The future, Caulfield said, is prevention.