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Mind the [Knowledge] Gap

2011 December 15
by Guest Commentator

Lea Velsher, MD CM, FRCPC (pediatrics), dipABMG

Dr. Velsher is a Fellow of the Royal College of Physicians of Canada, a Fellow of the Canadian College of Medical Geneticists, and a diplomat of the American Board of Medical Genetics. She is currently on active staff at North York General Hospital and a lecturer at University of Toronto. Dr. Velsher is active in the OMA, the Northern Regional Genetics Program and is a consultant for Medcan Clinic, the Familial Colon Cancer Clinic at Toronto Sunnybrook Regional Cancer Centre.

There exists an interesting dichotomy in society today: those who have seemingly unrealistic expectations for what genomics can and will achieve, and those who undervalue the current usefulness of genomics in medicine. What we need most in this era of genomics and personalized medicine is a healthy dose of level-headedness, open-mindedness and education—we need to close the knowledge gap.

 The field of clinical genetics developed around the diagnosis and assessment of single gene disorders and chromosomal abnormalities.  It is not surprising that dealing with genomic variability as it contributes indirectly to disease susceptibility doesn’t easily fit into this paradigm. The clinical genetics world has been slow to embrace genomics and its potential usefulness in the clinical setting.

Personal genomics fits well with clinical practice in other specialties. The information from a genomics assessment can be added to existing risk algorithms for common conditions such as coronary artery disease.  The concepts involved are common to medicine in general.  However, the science and the data are new and education in genetics is limited in medical school, residency training and continuing medical education programs.    There is limited genetics teaching for allied health professionals who provide primary or supportive care, such as midwives and nurse practitioners.

 We need to find ways to ‘teach the teachers’ about genetics and how the new technology and new information from genomics can be integrated into medical practice.   The integration of genomics into medical practice will then become part of the routine curriculum for physicians and other health care providers.

 As genetics professionals we need to engage the general public in order to foster an understanding of the value and the limitations of genomics and personalized medicine. I’d point to the Ontario Genomics Institute (OGI), which has a wonderful outreach program dedicated to connecting with students and the general public on this very subject.  

 We need to look at ways to bring genetic literacy to the general public on a basic level.   Just as children are taught about anatomy and health in grade school, they should also be introduced to the concepts of cells, genes and DNA.  We should encourage accurate and balanced reporting on genetic issues in the media and on popular programs that feature medical or health topics. 

There are a many challenges facing personalized medicine in Canada. It will gradually become part of routine medical practice.  This will happen faster in a community of well-informed health care providers and educated patients.  The challenge for us in the field is to find effective ways to make this happen.

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This post was submitted as part of the guest commentary series: What is the biggest challenge facing personalized medicine in Canada? _________________________________________________________________________

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