Does the future of medicine rest with our individual genetic code? That's the idea behind a $215 million White House and NIH initiative, launched in January, that will scour the DNA of 1 million volunteers. You may know it by its more enticing name: precision medicine.
Mayo Clinic is bullish on precision medicine. Mayo CEO Dr. John Noseworthy recently returned from the influential Aspen Ideas Festival, where he spoke at length on the subject. At the Mayo Clinic Center for Individualized Medicine, nearly a dozen clinical trials are underway involving some form of genetic research. And the clinic is sponsoring a symposium on the topic this September.
The clinic has plenty of company in its enthusiasm.
Precision medicine could "bring us closer to curing diseases like cancer and diabetes," according to President Obama. Francis Collins, the NIH directory and former head of the Human Genome Project, predicted in 2000 that gene-tailored medicine would be here by 2010. That's still our goal today. In 2005, the head of the National Cancer Institute laid out hopes of gene research "eliminating the suffering and death due to cancer by 2015." Here we are in 2015, of course, cancer still deadly. What happened?
As David Dobbs, an author for Buzzfeed recently put it, upon their discovery few of our genes held an obvious function. "Some seemed to do nothing. Some seemed to work fine one day but not the next, or to do one thing in one situation and another in another. … It is as if they cracked a safe they knew was packed with cash and found almost nothing."
"When we first started looking for gene variants, some people thought they'd find four, or five or six gene variants for common diseases," says Dr. Michael Joyner, a research physiologist and and anesthesiologist at Mayo Clinic. "Instead they are finding hundreds of gene variants and the size of their effect on risk is modest. … It turns out that multiple genes each explain only a tiny part of your risk."
Joyner is the author of "Seven Questions for Personalized Medicine," an articlepublished last month in the Journal of the American Medicine Association. It wasn't his first Debbie Downer missive on the bold new science that few of us understand but all of us imagine will be the Next Big Thing.
Earlier this year, Joyner authored a skeptical piece on personalized medicine that turned up on the opinion page of the New York Times. That pieceargued that "age, sex, body weight and a few simple blood tests are much better predictors of Type 2 diabetes … than a genetic score based on how many snippets of 'risky' DNA you have."
It goes without saying that his views on precision medicine are his own and not those of his employer. But he is not pessimistic about Mayo's efforts in precision medicine."I think the clinic's push is toward rare diseases and how drugs work," he says, "and I think those are reasonable goals. I haven't heard anybody at Mayo saying it's going to reduce health care costs or cause vast improvements in health."
Supporters of the initiative believe the science is close and only needs more data and bigger computer inputs. Let's hope they are right. We all would love to see the energy around precision medicine to have been put to good use. But if the ability to understand the human genome turns out to deliver less than advertised — if it does not cure cancer and diabetes and bring down costs — it will have joined cold fusion and flying cars as yet another high-tech dream deferred. In the meantime, we may neglect the simple things that we can do and learn more about today to reduce our risk of illness.
"At the very discovery there were critics," says Joyner, "epidemiologists who pointed out that 70 to 90 percent of common diseases had a cultural and environmental role."
Hopefully precision medicine will help relieve us of suffering and early death due to illness. But if it does not, our enthusiasm may say less about the science, and more about our our desire to avoid facing more challenging problems for our health, like changing our human environment, behavior and culture.