Healthcare revolution is now on the horizon
Written by Anne Kozak
October 10, 2008/Bar Harbor — Rick Woychik, president and CEO of The Jackson Laboratory, discussed concepts that will revolutionize health care in the near future – medicine and medical treatments that can be tailored to benefit a specific individual – during an appearance as part of the Acadia Senior College’s lecture series recently.
For ages, said Dr. Woychik, geneticists and physicians have known that genetic variability played a major role in how individuals responded to treatment, but until recently they could do nothing with that knowledge. But now, thanks to the results of the human genome project and the development of sophisticated tools for analyzing genetic variability, physicians and researchers have tools to factor in the role of genetic variability in individual patients.
Currently the practice of medicine is based on biological markers. If an individual’s blood pressure is less than 140 over 90, that person is considered healthy. If one exercises, eats nutritionally rich food and gets the minimum daily allowance of various vitamins and minerals, the person will be healthier,” said Dr. Woychik.
“I can personally speak to the whole issue of minimum daily allowance. I’m exceptional – a low B12 absorber. If I take the minimum, I get ill, so I take a mega-B vitamin. All it took was a blood test to show that I was deficient in B12.”
Tailoring medical treatment to the individual comes through the interaction between patient and physician – something which has generally characterized the art of medicine. Now physicians can order simple tests to better understand their patients’ genetic variability. Tests can be performed to determine a predisposition to cystic fibrosis, or to breast cancer. But what is important to remember, said Dr. Woychik, is that possessing a single gene does not predict a clinical outcome. Rather a single gene works in the context of thousands of other genes and proteins.
Using mice, researchers can test the effect of a single mutated gene on known genetic backgrounds. Jax researcher and associate professor Sue Ackerman studies neurodegeneration. Dr. Ackerman found a single gene that in a particular mouse strain causes aggressive neurodegeneration. When she put that same mutation into another strain, the neurodegeneration was substantially suppressed, and the mice did not develop the massive deterioration of the brain.
Just as no single investor, business or institution caused the current financial debacle, no single gene causes a disease. No single vehicle creates a traffic jam, rather several hundreds of vehicles do. Accidents tie up traffic and cause lots of secondary effects, but those effects are greater if the accident occurs during rush hour than if the accident occurred at 2 a.m.
Single genes, said Dr. Woychik, work in concert with thousands of other genes and proteins.
"We have an emerging vision of individualized medicine," said Dr. Woychik. "The maxim ‘one size does not fit all’ is particularly apt when researchers and physicians think in terms of individualized medicine" a concept that will characterize medicine in the 21st century."
Many who suffer from arthritis benefited from taking Viox, but some people died. Rather than making the drug off limits for all people, Dr. Woychik advocates testing individuals to differentiate those who benefits from and can tolerate Vioxx from those who have a predisposition to suffer adverse effects from the drug.
Sequencing the human genome took $15 years and $2 billion. James Watson, one of the initiators of the genome project, recently had his genome sequenced for $1 million.
Within five years, Dr. Woychik anticipates that with new technology a person can have his or her genome analyzed for about $5,000, and the price will continue to go down as innovative technology is developed.
"Knowing a patient’s genome and seeing sequence variations within specific genes known to be associated with the disease can tell us whether an individual is predisposed to a disease, but it doesn’t necessarily provide insights into what the clinical outcome will be for that individual. The situation is different for each gene, but, in many instances, having a mutation within a specific disease that predisposes one to a disease does not necessarily mean that the person will definitely develop that disease," said Dr. Woychik
He used Sergey Brin, the co-founder of Google, as an example. Mr. Brin has a mutation in a gene that predisposes a person to Parkinson’s, but "it is more likely than not that he will not develop the disease," because genes work in networks and environmental factors like diet and exercise can influence the clinical outcome associated with a genetic predisposition to a disease.
The Jackson Lab’s staff of 218 PhDs or MDs are using the power of mouse genetics to identify new genes associated with specific diseases, to develop new tools based on "systems genetics" approaches to understand how genes work in networks, and to understand the role of environment in the development of specific diseases.
"Jackson Laboratory scientists are working with physicians at clinical organizations to deploy their knowledge of basic disease mechanisms to improve the effectiveness of treatments for individual patients," said Dr. Woychik.
He predicts that the information lab scientists generate will grow exponentially in the next five to 10 years. More than 16,000 labs in 60 countries use the lab’s 4,000 strains of mice, and thousands of new strains likely will be distributed over the next several years. The lab maintains the definitive electronic database on mice through the Mouse Genome Informatics program - a program that allows scientists worldwide to share data in a format that facilitates new discoveries.
