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Personalized Medicine & Companion Diagnostics: Speaking with Keith Stewart, Director of the Mayo Clinic Center for Individualized Medicine

Editor’s Note: This week, we sit down with Keith Stewart, director of the Mayo Clinic Center for Individualized Medicine.

Real World Health Care:  Why was the Center for Individualized Medicine formed at the Mayo Clinic? What were its initial goals and how have those goals changed?

Keith Stewart, Mayo Clinic Center for Individualized Medicine

Keith Stewart, Mayo Clinic Center for Individualized Medicine

Keith Stewart:   The Center was formed in 2012 with the idea that it would harness the power of the human genome to improve health care for our patients. It was considered to be one of three transformative initiatives for the future of the Mayo Clinic and a discipline in which Mayo Clinic should be a leader.

RWHC: How has personalized medicine and the work you’re doing at the Center for Individualized Medicine helped the Mayo Clinic to improve health outcomes?

KS:   By using the genome as a lifetime resource and not just a “one and done” test, we believe we will lower the costs of health care. For example genomic knowledge will improve the precision of diagnosis, reduce unnecessary testing, allow the right drug at the right time and ultimately improve health outcomes.

RWHC: What types of companion diagnostics are being conducted at the Center for Individualized Medicine to identify the best therapy for individual patients?

KS:          Many. One good example is pharmacogenomics where we have created 18 drug alerts in the electronic health record already. But we have many other examples: cancer gene panels in prostate cancer, glioblastoma, myeloma, sarcoma, and colorectal cancer. Panels in cardiac disease and neurology, for example in peripheral neuropathy, epilepsy, and movement disorders. And, of course, whole genome sequencing for families with rare diseases.

RWHC: In your opinion, what is the most exciting translational research being conducted at the Center for Individualized Medicine?

KS:   I am very excited about our work in the microbiome and how that will impact human health and how we might use genomic sequencing in infectious disease to identify pathogens that are hard to culture. But there are many such areas. We will be sequencing the pharmacogenomes of 10,000 of our patients and launching clinical trials in the areas of organ transplant and immune-oncology next year.

RWHC: Where do you see the future of blood cancer-related personalized medicine and companion diagnostics heading?

KS:          As an example we have built and are launching a gene panel in myeloma which identifies mutations but will also call common translocations. If successful this should replace the era of conventional cytogenetics and FISH testing. The same will be true in acute leukemias and lymphomas. A major area of interest is in immune-oncology and we will be launching trials in this area next year to understand how genomics can select for patients most likely to respond.

RWHC: When full-genome sequencing becomes routine, what sort of information do you envision healthy people obtaining and applying as a result of having their genome sequenced?

KS:          I think the answer may not be what most people expect. Yes, we will find medically actionable things such as carrier status and pharmacogenomics, but to me, the most important thing might end up being what is negative. As an example, when I had my genome sequenced, it struck me that I would never again have to have any other genetic testing done for the rest of my life. So, if I have a blood clot, cancer, or develop Parkinson’s or dementia, I already know I am negative for the currently understood genetic risk factors.

Get Your Flu Shot Now to Stay Healthier Later

So you think you’re too busy to get your flu shot? It’s easy to put off, but taking the time to do it sooner rather than later could prevent you from getting sick while helping to protect those you care about – during the holidays and beyond. That’s why the U.S. Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC), state and local health departments as well as other health agencies are raising visibility around National Influenza Vaccination Week (NIVW), from Dec. 8-14.

Paul DeMiglio

Paul DeMiglio

With the flu season beginning in the fall and not peaking until January-February, it’s certainly not too late to get your influenza shot. In fact, the CDC’s Advisory Committee on Immunization Practices recommends that everyone 6 months of age or older receive it, including:

  • Children
  • Seniors 65 and older
  • Pregnant women
  • American Indians and Alaska Natives
  • Those with underlying health conditions like asthma
  • Those living with conditions including chronic lung disease, heart disease, HIV/AIDS, cancer and diabetes

Although the effectiveness of flu vaccination varies each year, the CDC reports that recent studies demonstrate the evidence-based public health benefits. The Mayo Clinic agrees, calling flu shots your best defense against the flu, enabling “your body to develop the antibodies necessary to ward off influenza viruses.”

“The single best way to protect against the flu is to get vaccinated each year,” said CDC’s Anne Schuchat, M.D., Director, National Center for Immunization and Respiratory Diseases. “Today, flu vaccines are available in more convenient locations than ever. The few minutes it takes to get a flu vaccine can save you from experiencing several unproductive days due to influenza. The most common side effects are mild and short-lasting, especially when compared to symptoms of influenza infection.  Flu vaccine cannot cause flu illness.”

Despite evidence that the influenza vaccine is an effective tool, some still fear that getting their shot might put them at risk for experiencing severe side effects. No more than one or two cases per million people vaccinated acquire Guillain-Barré syndrome, an outcome much lower than the risk of developing severe complications from influenza. From 1976-2006, in fact, estimates show that far more people died from flu-associated deaths in the U.S. (3,000-49,000) than from negative reactions to the vaccines that protect against influenza.

To build awareness and support of NIVW and encourage people to get their shots, the CDC is making a rich variety of online tools and resources available to a wide spectrum of patients, educators and providers, such as:

Partnering with Reckitt Benckiser, Inc., the makers of LYSOL® Brand Products, the CDC is also spotlighting the Ounce of Prevention Campaign, which seeks to empower consumers and professionals with practical tips and information around effective hand hygiene and cleaning habits to prevent infectious diseases like the flu.

Click here to see if the vaccine is available in your area. To find a nearby location to get the vaccine, check out HHS’s “Flu Vaccine Finder” on Flu.gov, enter your ZIP code and share the widget to let your family members, colleagues and friends know where they can go too. HHS also provides a series of informative YouTube videos that cover prevention strategies, share tips for identifying symptoms and provide recommended treatment practices.

You can also make a powerful statement by taking the pledge to get vaccinated for the 2013-14 season, commit to taking a friend with you and in the process spread the word by clicking here. To get the latest updates on flu vaccination efforts, follow the CDC on Twitter (@CDCFlu and @CDCgov) and “like” them on Facebook.

Now tell us if you’ve gotten your flu shot. Where did you go? How long did it take? What ways could providers and health care stakeholders more effectively remind patients to get vaccinated?

Support and Health Information for Breast Cancer Patients Just a Click Away

As we saw in last week’s post, the American Cancer Society (ACS) is helping to change the way those living with breast cancer access the information they need to live healthier.  But ACS is not the only organization that’s empowering patients, especially women, to take control of their health through innovative online tools both during and after National Breast Cancer Awareness Month.

Linda Barlow

Linda Barlow

Breastcancer.org is a nonprofit organization dedicated to providing the most reliable, complete and up-to-date information about breast cancer and breast health as well as an active and supportive online community. The organization’s website, which is also available in Spanish, provides information and resources about symptoms and diagnosis, treatments and side effects, day-to-day matters of living with breast cancer, and how to lower your risk. A Community portal features discussion boardschat rooms, a blog, and a link to Ask-the-Expert online conferences.

CancerCare is a non-profit organization that provides telephone, online and face-to-face counseling, support groups, education, publications and more – all for free. Its Breast Cancer web page offers information about upcoming workshops and links to breast cancer-related podcasts to more than 1 million visitors each year.

The Mayo Clinic and the Mayo Clinic Cancer Center offer a range of breast cancer treatment services and conduct ongoing cancer research. A special Breast Cancer page offers basic information about breast cancer, from symptoms, causes and risk factors to how to prepare for a breast cancer-related doctor’s appointment. In-depth information is available for those who want it, along with a FAQ and a blog written by a Mayo Clinic nurse educator.

“Breast cancer patients and their loved ones need both support and reliable information,” said Katie Freeman, Communications Coordinator, CancerCare. “Fortunately, with our online services and support groups, patients don’t have to face these challenges alone.”

MyHealthTeams was created as a network of social media platforms to serve as a resource for chronic condition communities, to make life easier for those diagnosed with a disease – and their families – to connect with others, share their daily experiences, and find the help they need. Since its founding in 2010, MyHealthTeams launched three social networks – MyAutismTeam, for parents of children with autism; MyBCTeam, for women facing breast cancer; andMyMSTeam, for those living with multiple sclerosis.

Susan G. Komen for the Cure, through events like its Komen Race for the Cure, has invested $2 billion to end breast cancer in the U.S. and throughout the world through groundbreaking research, community health outreach, advocacy and programs in more than 50 countries. Komen’s website offers a number of resources and interactive tools, both for patients who have been diagnosed with breast cancer, and for those who know someone who was diagnosed with breast cancer. A message board and a blog let those touched by breast cancer share their stories, questions, and information about breast cancer news and education.

These are just a few of the organizations helping to support those living with breast cancer and their loved ones. Have you been diagnosed with breast cancer or know someone who has? What are the organizations and websites you’ve turned to for help and information? What resources – particularly online platforms – have you found to be most effective in addressing your needs as a patient or as a family member of someone living with breast cancer?

Categories: Access to Care

This is Not Your Father’s Oldsmobile, Nor Your Child’s Social Network

David Sheon

David Sheon

Does social networking conjure images of teenagers who share seemingly worthless online videos of watermelons dropped from atop buildings? Well get this:

Americans OVER age 45 represent the largest percentage increase in social media usage in the past year, now up to 38 percent in 2012, compared to 31 percent in 2011 (Source: Edison Research).

What does this mean for improving health care outcomes?  At least one analysis finds a prolific growth in online patient communities, where peers help one another find solutions, determine the right time to go to the doctor, and essentially crowd source solutions to their problems.

Many social networks specifically for patients have launched using a number of different business models.  Here are just a few:

  • Inspire has social networks for patients with various diseases and health conditions, each sponsored by health organizations.
  • The Mayo Clinic has created a platform for patients with various diseases, not limited to the 500,000 patients treated at the Minnesota-based hospital system annually.
  • Patients Like Me is a web-based portal for patient-to-patient communication that was started by two brothers at MIT.  They pledge complete transparency in terms of funding sources.
Are social networks resulting in better outcomes or improved access? Any success
stories out there you’d like to share? What are some of the best sites for connecting with others who have similar health conditions?

Categories: Access to Care