You’ve probably heard a lot about “personalized medicine” and may well wonder whether it’s a serious approach to improving patient care or just a lot of hype. Actually, it’s both.
Clearly it is not yet close to being an accepted or routine part of medical care. But in certain areas, oncology in particular, clinicians are increasingly basing treatments on the patient’s genetics. As you’ll read in this issue of Stanford Medicine, treatment tailored to each individual is moving from concept to care.
What does this mean in practical terms? For one thing, medical schools must prepare future physicians to work within this new paradigm. Yet few medical schools systematically teach clinically relevant genetics. In fact, a recent study of U.S. and Canadian medical schools found that only 11 percent offered practical training in the use of medical genetics (Thurston et al., Academic Medicine, 2007). And not surprisingly, practicing physicians’ genetics knowledge is underwhelming. This is especially concerning given the pace of new knowledge and the fact that this will continue to increase rapidly in coming years.
Physicians are already fielding questions from patients who’ve had genotype profiling. And most physicians are unprepared to answer them. In fact, most of the primary care physicians in a national study couldn’t correctly answer questions about even single-gene tests for common diseases (Wideroff et al., Journal of Medical Genetics, 2005).
The good news is that many medical schools, including Stanford, are revamping how we teach medicine. Partly we’re motivated by the centennial anniversary of the Flexner report, which set the stage for the education models that still exist in many programs. But even more, we’re motivated by the needs we see before us.
In the past year here at Stanford we’ve had a vigorous debate about a proposal to incorporate the genotyping of medical students into molecular medicine and genetics classes as a way to make genomic testing more real. An article in this magazine fully describes the many ethical questions stirred up by this issue. After months of deliberation, we approved a course that was led by one of our medical students this past summer. To my knowledge it is the first medical school class anywhere to include genotype testing.
Meanwhile, research continues to fill in details about our molecular makeup, painting an exquisitely complex picture. While an individual’s genome sequence will surely become a powerful tool for personalizing medicine, it will be only part of the story. Even greater success at tailoring treatments will come with new knowledge about the genes’ regulators — the proteins and other chemicals that switch them on and off. As you’ll read in this magazine, research into gene regulators is burgeoning.
So I encourage enthusiasm concerning personalized medicine but also caution because of the still nascent state of our knowledge. Though it remains a work in progress, and will evolve in ways that can only barely be predicted, it is already having an impact. But we need to be cautious that hype doesn’t create false expectations and that we stay grounded in science as we seek to incorporate the emerging concept of personalized medicine.
Philip A. Pizzo, MD
Stanford University School of Medicine
Carl and Elizabeth Naumann Professor, Pediatrics, Microbiology and Immunology