I heart personalized medicine

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“Genetic information is not a black and white science,” says personalized medicine pioneer, Dan Roden, BSc’70, MDCM’74.

By Sophia Blankenhorn

Where are we at with personalized medicine today?

To answer, Dan Roden, BSc’70, MDCM’74, cites the example of Hollywood actress Angelina Jolie.

In 2013, Jolie underwent a double mastectomy after genetic testing revealed that she carries a breast cancer-causing mutation of the BRCA gene.

It can be difficult, Roden explains, to determine when a particular genetic variation will be important for a particular patient. “In the case of Angelina Jolie, she has an incredibly strong family history of cancer so the genetic testing could be a good predictor. But what do you tell someone who is thirty years old, has a variant in the same gene and no family history?”

Roden is the recipient of the McGill Faculty of Medicine’s 2017 Medicine Alumni Global Lifetime Achievement Award.

He is speaking to Medicine Focus from his office at the Vanderbilt University Medical Center in Nashville, Tennessee, where he is Senior Vice President for Personalized Medicine, Professor of Medicine, Pharmacology and Biomedical Informatics, and Director of the Oates Institute for Experimental Therapeutics.

“For most patients, the first treatment is the right one,” says Roden, whose own research focuses on identifying mechanisms of underlying variable abnormalities of cardiac rhythm and mechanisms and responses to antiarrhythmic drug treatments. “But some won’t respond appropriately to the average or standard treatment. They need something else.”

There are, however, many barriers to a personalized approach.

There is the challenge of performing genetic testing, of analyzing the data, and of educating health care providers on how to best use the resulting information.

Hence the creation of the Vanderbilt DNA databank BioVU, fifteen years ago.

“It took several years of planning to get to the point where the bio bank would be collecting samples. We now have almost a quarter of a million samples. It is the largest single-site bio bank in the world,” says Roden, Director, BioVU, who is working on one very ambitious project involving the genetic testing of 25,000 people.

“It has really turned into a tool for discovery in ways we did not anticipate. And that is one of the things that makes it fun,” says Roden.

But, he says, there is more work to do.

For one thing, more data is needed. “A genetic variant may be associated with an increased risk for breast cancer or abnormal heart rhythm, but, as of now, there is no sure way to know the level of risk. Building large internationally based data bases, where people can go and look up this information, would be a huge advance.”

And, even if we had the data, there is the question of knowing what to do with it.

Roden is also a leader of Vanderbilt’s PREDICT project, which collects pharmacogenomic variant data and enters it into electronic medical records. By collecting the genetic data and then allowing that information to live in an electronic record the information becomes more accessible. “When a drug is prescribed we have the genetic information in the system, so we know that that person should get a different drug, a different dose, or may be at risk for certain complications.”

Or, he says, that is the vision.

The reality, he explains, “is quite difficult.” He distinguishes between BioVU, which is a discovery engine,” and the subsequent challenge of figuring out how to “deliver this information in a way that doesn’t interfere with the flow of health care.”

In the spring, Roden, a former managing editor of the McGill Daily who worked for the Montreal Gazette as a beat reporter before entering the undergraduate medical program, addressed the Faculty of Medicine as a Holmes lecturer. His advice for current MDCM students? “Taste the research career at some point.”

He returns to Montreal over Homecoming Weekend (Oct. 12 to 14) to accept his Lifetime Achievement Award.

When asked what this recognition means to him, Roden says, “I will tell you it is incredibly special. I have received awards from national organizations and given named lectures in dozens of places. They are big honours and fun, and I think it is sign of successful career, but being asked to come back to your home territory to accept an honour like this is very special and I am very grateful. I told my 93-year-old mother I was getting this award and the very first thing out of her mouth was ‘I would love to be there,’ so she will be.”

 

 

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One Response to “I heart personalized medicine
  1. Congratulations Dan! Proud of you and your work. Jane

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