Time not on your side: Challenges of genomic medicine
Stephen W. Scherer, PhD, FRSC
Dr. Stephen Scherer is the Director of the McLaughlin Centre and The Centre for Applied Genomics, affiliated with both the Hospital for Sick Children and University of Toronto. Dr. Scherer leads one of Canada’s busiest laboratories. His group has discovered numerous disease susceptibility genes and most recently has defined CNV and other genetic factors underlying autism. He collaborated with Craig Venter’s team to decode human chromosome 7 and to generate the first genome sequence of an individual. Link to complete bio here: http://www.tcag.ca/scherer/
In my opinion the biggest challenge facing personalized medicine (what I prefer to call genomic medicine) in Canada will be time demands imposed on health care workers and professionals. The cyclical nature of personalized or genomic health investigation is driven by a constant flow of questions and knowledge between medical practice and research (both ‘bench to bedside’ and ‘bedside to bench’). In such a model, investigation guides informed medical questions, which yield solutions that feed back to individuals, families and populations in a natural progression, and which have an impact on health. Such progress may be constrained, however, simply by the sheer time it will require to deal with the thousands needing the ‘new care’. There will also need to be significant collaboration with scientists and cross-disciplinary health consultation, which currently only (partially) exists in well-endowed teaching hospitals and medical schools.
To meet these demands it is likely that the health care system as a whole will have to change. I suppose, there will be an immediate need for educational tools to transfer the vast amount of knowledge to health care providers. Moreover, a new generation of technologists and genetic/ genomic counsellors will need to be trained to interpret the new genome-wide and health-related datasets. Furthermore, there will be a requirement for the development and implementation of health information tools, such as electronic capture and filtering, to facilitate the collection and interpretation of medical histories and outcomes. Finally, the general education of the public will also have to be elevated so they can actively participate in the necessary informed decision-making around their own health. The practice of medicine is already moving in the direction of a personalized paradigm, but the pace is slow and incremental, one patient at a time. The time spent on each patient will increase, which is good for the patient, but probably not so good for the current system.
This post was submitted as part of the guest commentary series: What is the biggest challenge facing personalized medicine in Canada? ____________________________________________________________________________