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One Size Does Not Fit All: Looking To The Future of Medicine With Dr. Eric Green

A mannequin on display at the Smithsonian Museum of Natural History in Washington, DC
greyloch via flickr/

If you wear eye glasses or contact lenses, chances are they’ve been specially calibrated to your unique set of eyes. If you’ve ever received a transfusion, you’ve (hopefully!) received blood from a donor with a compatible blood type. So why not cancer and diabetes treatments that are specific to individual patients’ bodies?

A major push is underway to move medicine away from the one-size-fits-all approach, to an era in which drugs and other treatments are crafted to fit individuals. In January, President Obama asked Congress for $215 million for the Precision Medicine Initiative, a major project to collect genetic information and combine it with health data with the goal of creating treatments tailored to individuals. In April, California Governor Jerry Brown announced a statewide precision medicine initiative, calling it a “Google Maps for health.”

Dr. Eric Green is director of the National Human Genome Research Institute, part of the National Institutes of Health. He says precision medicine is in its early days, but successes so far have been inspirational. He spoke with Sound Medicine Radio Show host Barbara Lewis about the two major parts of the initiative: innovations in cancer treatment; and collecting genetic data from one million Americans. Listen to the interview or read highlights below.

On why precision medicine is important 

“As a physician I can tell you, it's not like we don't attempt to be precise in the practice of medicine. But the truth of the matter is: for most of the things that we do in medicine now, we act as if an average patient is in front of you, because that's the best tool we have available to us. When we pick medications and therapies we make our best judgments based on data that we have of the average patients. We can do better than that.”

One early successes in cancer treatment

“Some of the earliest wins have used information about a specific tumor's genomic make-up - the DNA in the tumor that has been deranged. The reason the tumor is growing out of control is there have been changes in the DNA in those cells. And because of tools and technologies of genomics...we are now able to study the genome of that tumor. And that has opened our eyes to all sorts of important information. For some specific types of cancer that has truly led to some spectacular benefits.

We know the underlying biology of what's gone wrong, whereas ten years ago we were blind to that. We were just pouring poisons into people and hoping that on average some of the people would benefit from this. We believe that we are now in a position over the next five, ten, 20 years, that we are in a position to generalize this approach to dozens and dozens of types of cancer.” 

On why it’s important to collect DNA from a million Americans

“We're Americans: we do things big and bold. But we're also a melting pot of individuals and we have a lot of people that have come from all different parts of the world. We have to make sure that we have an appropriate diversity of participants, so that everyone's represented, based on their geographical origin in particular.

Another reason we're doing it on this scale is findings in recent years indicate to us that for a lot of diseases, very common diseases that fill hospitals and clinics around the world -- diseases like diabetes, diseases like hypertension, mental illness, cardiovascular disease and so forth -- every one of those diseases are [really] dozens of sub-diseases. And what's very clear is that to untangle the unique aspects, both of the genomics and the lifestyle and environmental contributions to those sub-types will require studies of tens of thousands - probably hundreds of thousands of individuals. So to really get at all of these important contributions to human disease so that we can be precise is gonna require scale that will need a cohort of at least a million individuals.”