The National Institutes of Health is slated to receive $215 million with the hope of individualizing medical treatments by using patients’ genetic information.
In his State of the Union address on Jan. 20, President Barack Obama announced the Precision Medical Initiative, a program with the goal of enabling doctors to better understand diseases through genetic sequencing of patients and ultimately choose better treatments. In cancer treatment, for example, a patient’s tumor might be sequenced to uncover the specific mutations causing the disease, and physicians will use that information to select the right drug or predict which will be most effective. The approach has gained traction in the treatment of cancer and rare genetic diseases, but is not available for all patients and is yet to be widely applied to other diseases.
“Precision medicine, using genomic information in a way that affects their clinical decisions about care, is already here and now,” said Eric Green, director of the National Human Genome Research Institute, which carried out the Human Genome Project and is now working to apply that research to solve medical problems. “This is not science fiction, but we are just starting to ascend this mountain. This will be a very long climb, but once we get to the top, you will see genomics being used all over the place.”
Green said genetic sequencing in cancer and rare genetic disease treatment saves valuable time and money.
According to professor of medical oncology and Associate Director of the Yale Cancer Center Roy Herbst ’84, Yale is already using genome sequencing to personalize treatments and predict the effectiveness of drugs for patients at the cancer center, allowing physicians to “find the right drug, for the right patient, at the right time.”
But the hope is for the practice to reach a larger population of cancer patients than it does now and ultimately to apply genome sequencing to other diseases.
According to Green, the latter will be more complicated. With diseases like diabetes, arthritis and hypertension, there is a complex interplay between environmental and genetic factors. But the complexity of figuring out how to use genetics in those more complex diseases makes for an even stronger argument to create the Precision Medical Initiative, he added.
Dean of the Yale School of Medicine Robert Alpern said that although the possibility to improve treatment for cancer and other diseases is there, more funding is still needed.
“We’re at this somewhat frustrating point where the science has never been in a better position to create ways for us to cure diseases that, frankly, when I went to medical school I thought could never be cured, and now there’s not enough money,” he said. “The NIH budget just doesn’t keep up with inflation. We’re at a point where we can do so much and the money has never been so limited.”
Alpern added that Yale is a leader in the use of genomics in personalized medicine — the University even has a genome center on West Campus — and is primed to turn additional funding into breakthroughs.
According to Green, the area where those breakthroughs are most needed is in better understanding the variance between individuals in a given disease.
“We’re using blunt tools,” Green said. “We’re saying everyone that looks the same gets treated the same.”
The hope, he added, is to stratify classifications of individuals with various diseases, similar to how cancerous tumors are classified and treated accordingly. Understanding those variations will help physicians to understand who will respond well and who will respond poorly to certain treatments.
Herbst noted that Yale is already applying these strategies, but that funding will be invaluable in establishing more clinical trials for patients and collaborations with other institutions. While Alpern commended the initiative, he said he is frustrated by the level of funding, calling it “a drop in the bucket” compared to the entire federal budget and that of the NIH.
“Preventing disease is always cheaper than treating disease,” he said.
Obama’s proposed $3.99 trillion budget for the 2016 fiscal year contains $30.362 billion dollars for the NIH.