“How are you feeling? What brings you in?” your doctor asks on your visit. She is in search of clues which, perhaps combined with a blood test or a scan, can lead to a diagnosis. Hopefully, for the condition identified, there is a treatment to which you respond well and without side effects. If not, you schedule a next visit for more tests and a new prescribed therapy.
This scenario is familiar to us all. It is a trial and error, traditional approach to medicine—but it’s not the ideal one when it comes to our health. Now, imagine your doctor welcoming you armed with details from your electronic medical record about your treatment history, lifestyle and behaviors, and with insights and knowledge about your genes, your metabolism, and the composition of your gut microbiome. This information will transform your visit, enabling patient and physician alike to manage and fine-tune individual health. For example, your doctor may prescribe a drug or supplement to prevent a health threat for which you are at risk. She may know ahead of time that a certain cancer treatment won’t work for you, and can help you avoid a plethora of serious side effects.
By examining newly available troves of health data, including genomic sequences, patient health records, and the results of diagnostic tests, we can make predictions and recommendations about care. This kind of approach to healthcare is the ultimate goal of the Precision Medicine Program at Brigham and Women’s Hospital.
Why now
At the heart of precision medicine are two major scientific and technological advances: First, the increasingly widespread use of Electronic Medical Records (EMR), which have made it possible for healthcare systems to collect vast amounts of medical data in an electronic and potentially searchable format; and secondly, the sequencing of the human genome and the phenomenal drop in cost of sequencing technology which has made genetic profiling widely available.
The earliest efforts in precision medicine have focused primarily on making sense of genetic data and using it to inform patient care. This is exemplified in cancer care, one area where precision medicine has made significant progress by enabling physicians to target specific mutations and cellular pathways that cancers exploits for their survival and propagation. At Brigham and Women’s Hospital we intend to expand this approach significantly. We believe that to truly transform health care we need to understand the multiple factors that might influence health and disease, including but not limited to genetic analysis. We are taking advantage of sequencing technology in the context of multiple other data sources—pathology, metabolomic, proteomic, imaging, and other clinical data—to tackle diseases we know are ripe for this type of approach.
We have already begun early testing of this approach, launching projects as proof of concept trials. Our early-phase work has resulted in a paradigm shift in medical practice. We aim to expand our efforts, creating an effective living laboratory for precision medicine practice at Brigham and Women’s Hospital. The ultimate goal of all precision medicine projects we are embarking on is to identify factors that predispose individuals to a disease, study the molecular mechanisms that cause the condition, and then tailor prevention strategies and treatment to each person.
Why at Brigham and Women’s Hospital
Brigham and Women’s Hospital (BWH) is an ideal site for the development, testing, and implementation of precision medicine approaches at scale and across multiple medical specialties.
BWH is one of the largest academic medical centers in the United States. We are a key Harvard teaching hospital, the second largest hospital recipient of federal research funding in the country and ranked among the best in our peer group for clinical care. We draw on the talents of a population of nearly 5,000 investigators, including over 1,400 MDs/PhDs, and a full range of clinical and translational research centers of excellence across diseases including, but not limited to: cancer, cardiovascular disease, infectious and immune-mediated diseases.
We have a strong history of medical firsts. Research carried out at BWH has already delivered several fundamental improvements in patient care: the first solid organ transplant was performed at BWH and more recently the first face transplant; the TIMI study, headquartered at BWH, has transformed the practice of cardiovascular medicine by better understanding the risk factors of cardiovascular disease and by tailoring interventions. These are among the celebrated achievements of a community driven by tenacious determination and hard work in understanding disease and delivering better care.
In addition, BWH is an integral part of the Boston research and innovation ecosystem. At the core of this network are over 30 universities – among them Harvard, MIT and Boston University. Virtually every large pharma company has a presence in Boston; Sanofi, Pfizer, Biogen-Idec, Novartis and Vertex are all established large research centers in and around Boston and are complemented by the largest concentration of healthcare biotech/start-ups in the world.