Does gathering a lot of information really lead to better health?
The Mayo clinic is conducting future research on a high-tech approach called precision medicine. This involves collecting large amounts of information from genetic tests, medical records and other data sources to gather unexpected ideas to promote health. But a longtime scientist at the Mayo clinic is not playing.
Dr. Michael joyner is the voice of a skeptical sea. Joyner’s lab practice. It was appropriately placed in hospital buildings built in the 1880s. Although the Mayo clinic in rochester, Minnesota huge set up various new laboratory on campus, but Joyner can without using DNA sequencing machine and other high-tech precision under the condition of medical tools to carry out their work.
It was not just that he was an old-school devotee. He believes that solving our most pressing health problems involves thinking about the entire human race, rather than breaking everything down into DNA sequences.
“This [precision medicine] enthusiasm is taking place in a country where life expectancy actually declines,” he said as he walked past the old linoleum floor of st. Mary’s hospital.
Only by the fact that Joyner will ask, high-tech medical research money really solve the countries serious health problems, such as obesity, heart disease, high blood pressure, diabetes, alzheimer’s disease and cancer.
Volunteer Greg Ruegsegger was equipped with a monitor, a catheter inserted into a vein and a mask to measure human performance in a study conducted by Joyner.
Joyner says there is certainly an appropriate place to use the technology, and he is not opposed to the personal success stories that his colleagues tout. But he argues that the best way to address the health problems facing the nation is to study and treat the entire population, rather than breaking it down into billions of genetic fragrances.
He practices what he teaches in his personal life – his comprehensive practice includes cycling to work and his physiology lab.
On the day of my visit at the end of August, volunteer Greg Ruegsegger was equipped with a monitor, a catheter inserted into a vein and a mask to catch his breath. When scientists study him, he will exercise to the point of exhaustion. This is far more informative than any genetic test, Joyner says.
“People see 3000 elite endurance athletes – who is the tour DE France cycling race in the competition and won an Olympic medal in cross-country skiing and long distance running, and [scientists] has been unable to find any genetic markers of performances.”
When it comes to people’s health, Joyner talked about the real world, these findings suggest that walk or bike to work on the influence of body mass index of four to five times more than the person’s genetic profile.
Joyner focuses on how the body system works together during exercise, but the same correlation applies to many diseases. That’s why cancer drugs for a biological pathway usually don’t last. Tumor cells just find a solution, using the redundancy embedded in biology. That’s why jonah has so little faith in science that he has been trying to focus on smaller and smaller details.
“When we get these big initiatives, one of the questions we have to ask ourselves is, ‘what is the definition of success? ‘he said.
Scientific discovery is not for him. Doctors need to establish effective treatments – patients need to follow. It has long been a promise of precision medicine, but Joyner has published articles (such as this article) that are skeptical of the power to gather large amounts of information, hoping to understand it later.
“Is this just a biological tower?” he asked. Or will this information lead to the discovery of transcendent laboratories that actually change public health?
He has no doubt that DNA sequencing and other sophisticated medical tools are useful in certain situations, such as diagnosing rare diseases. Has some use in cancer treatment, but so far, only one according to the tumor DNA profile is assigned to the treatment of patients with random research, and it has no better than the traditional medical judgment.
Elsewhere in the Mayo clinic, this is not a popular idea, and the clinic spends hundreds of millions of dollars a year on sophisticated medical bills. In addition to Joyner’s physiology lab, the shiny new lab on campus seems to be a world.
After talking to Joyner, the Mayo public affairs officer eagerly directed me to a series of scientists who disagreed with him. One stop is in the medical genome facility.
The room was crammed with machines worth hundreds of thousands of dollars. They can analyze the DNA of a person, a tumor, or even a human cell. They can read the entire genome, or just a subset, the so-called exon group.
“I do believe that understanding our genome is very important,” said Julie Cunningham, one of the three co-directors of the facility. Like other Mayo scientists, she has her own exome sequencing.
“As far as I know, in general, I’m really lucky, but I know that I have two [genetic] mutations that affect my response to a particular drug.” She did know one of these drugs before, “but now I know exactly why I have it, and it could be serious, it’s good, there’s no problem.”
Adverse drug reactions are a serious medical problem, so in principle, the genome spectrum should help reduce risk. But the reality is that the vast majority of drug-sensitive genomic tests give ambiguous answers.
One of the most carefully studied examples involves blood thinners warfarin. Four independent studies have shown that people who get the genome test do not have a better — or just a slightly better — dose than the patient’s dose is determined by the traditional strategy.
The lack of strong data is a problem for many areas of precision medicine.
“While we think it will be on the concept of high value, and will end up with a better quality and lower cost to improve health care, but we have to prove it,” to guide the Mayo hematologist individualized medical center Keith Stewart said. “If it can not completely eliminate the way we expected, but I think there will be many unexpected ways we haven’t conceptualization, so I think that the taxpayer’s point of view is well worth the investment. ”
Whether precision medicine is going to be a boom or bust, he says, “now it’s just a guess.”
“Everyone in this country has their own genome sequencing, which is inevitable.” “He added.
Gianrico Farrugia, a gastroenterologist at the Mayo clinic in Florida, agrees.
“What we’re starting to see is that technology is invading and replacing traditional testing,” said Farrugia. For example, it has been used to determine lung cancer treatment and diagnosis of rare diseases.
And, in any case, he says, medicine has been actively entering this new field, and there is no turning back. “It’s not just wrong,” he said. “it’s impossible.”
With the momentum behind the business, precision medicine will be seen as the bulk of modern medicine. In hindsight, it already has a place in clinical practice.