Call by Ralph Snyderman (Duke U.) for Big Changes to Get to the Next Level of Precision Medicine

Beyond next-generation gene sequencing and developing diagnostic tools and targeted therapies, theoverall approach to clinical care has to be re-envisioned to fulfill the promise of precision medicine. Care must move from sporadic treatment of episodic disease (a reactive mode) to predicting disease and then acting to prevent and mitigate it (a proactive mode).

“I suggest that a broad based blue ribbon taskforce be created to quantify the needs for a growing precision medicine workforce. Based on the taskforce’s recommendations, the changes needed in educational curricula as well as new training pathways could be determined. A comprehensive needs assessment for the workforce underlying the advancement of precision medicine is a vital, given the rapid expansion of the field and its potential to improve health care delivery.” – Ralph Snyderman, MD is Chancellor Emeritus, Duke University and James B. Duke Professor of Medicine in the Duke University School of Medicine.

In order to reach and translate the goals of large scale initiatives such as the All of UsResearch Program, the current health care delivery system must be re-designed for health promotion, comprehensive disease prevention, and efficient adoption of precision medicine capabilities. This approach requires abandoning the reactive “find-it-and-fix-it model” of the current health care system and instead focusing on preventing and mitigating the complex chronic diseases that today account for about 80% of health care expenses.

Quantify and prevent diseases
Since diseases are most often triggered by both genetics and environmental factors, the risk for disease should be quantifiable and preventable with emerging, innovative tools. And once the disease and its underlying molecular and cellular mechanism is identified the disease should ultimately be treatable with precision.
A prospective precision health care model aims to reorient front-line care so that…

  • each individual’s health care risks are identified and stratified early,
  • healthful behavior is being promoted, and
  • disease is either prevented or treated with precision.

A precision health care model such as this uses….

  • optimal clinical judgment,
  • best available risk-assessment tools,
  • patient engagement,
  • disease-tracking biomarkers,
  • precision diagnostics,
  • targeted therapies and
  • customization of care for the individual patient in the form of personalized health planning (PHP).

Academic health institutions play a broad role in the introduction and utilization of precision medicine, ranging from enabling research to creating the clinical teams and processes involved in care, establishing appropriate comprehensive data bases, and analyzing the clinical data. Each of these functions requires well-trained individuals. By academic health centers becoming operational in all these areas, the optimal nature and structure of the workforce to adopt and advance precision medicine will be defined.

A main challenge for health care is the effective clinical adoption of precision medicine capabilities to improve outcomes. Academic health institutions are vital for the broad implementation of precision medicine by:

  • Performing research enabling new technologies
  • Validating new technologies
  • Creating capabilities to enhance patient engagement
  • Adopting precision medicine technologies into clinical practice and developing standards of care
  • Collecting data that can be curated and analyzed to continue to refine the best clinical utilization of emerging technologies
  • Training the workforce needed for precision medicine
  • Perfectly aligning the core missions of academic health institutions with the needs for the field of precision medicine while recognizing and embracing existing and emerging opportunities

Dr. Snyderman is widely recognized for his contributions to the development of more rational, effective and compassionate models of health care, and as such, has led Duke Medical Center into an internationally recognized, leading institution of academic medicine. He was among the first to envision and articulate the need to move the current focus of health care from the treatment of disease-events to personalized, predictive, preventive, and participatory care that focuses on the patient. We are excited to have Dr. Snyderman chair the “Precision Medicine Workforce” Panel this September 24-25 at PMWC 2018 Duke joined by Dr. Jeffrey Balser (Vanderbilt University Medical Center), Dr. Catherine Lucey (UCSF), and Dr. Suanne Haga (Duke University School of Medicine).

“Making genomic information available to clinicians preemptively, “available the moment I need it,” rather than exclusively through reactive testing, has the potential to transform clinical decision support.”

Dr. Jeffrey Balser is President and CEO of Vanderbilt University Medical Center and Dean of Vanderbilt University School of Medicine will share his perspectives on the emerging needs of the health workforce in order to implement precision medicine at scale in large health systems. Read the full interview.

Health professions education is where high quality health care begins. Precision Medicine will accelerate our collective ability to improve the health of our patients and communities. Medical Education must be redesigned now to prepare today’s physicians for transformational changes in the ways we engage with patients and prevent, diagnose and treat disease.”

Dr. Catherine Lucey, UCSF will focus on Preparing Physicians for the Precision Medicine Era. Read the full interview.

Dr. Susanne Haga, Associate Professor at Duke University School of Medicine, Department of Medicine and the Center for Applied Genomics & Precision Medicine. Her research interests focus on issues affecting the translation of genomics to clinical practice, particularly in the field of pharmacogenetic testing, and patient and provider education.

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