March 2008
Personalized medicine's promise

Jared N. Schwartz, MD, PhD

There are lots of skis in baggage claim when you travel in February. People are returning home from snowy resorts and the in-flight magazines feature mountain retreats that offer "panoramic steepness at the summit" and "pure vertical exhilaration."

Returning from the Molecular Summit in Philadelphia on Feb. 6, I had to tip my hat to whoever named the meeting. They captured it perfectly.

Publishers of "The Dark Report" presented the Molecular Summit as an opportunity for professionals in pathology and radiology to learn firsthand from physicians, scientists, and industry leaders about the integration of imaging and diagnostics and the advanced uses of molecular technologies. I make a point of staying informed, but an intensive meeting that brings together so many of those working on the cutting edge can set me back on my heels nonetheless. And knowing that pathology is so much a part of the biggest news in medicine does feel a lot like standing at the top of a steep downhill slope. Exhilarating. Exactly right.

Advances in molecular medicine, including genomics and proteomics, are creating new opportunities to expand our scope of practice and to affect patient treatment in new ways. These changes are expected to provoke healthy environmental responses. Anatomic and clinical pathology will grow closer. Pathologists will become increasingly engaged in new measures to prevent and even preempt disease. The electronic medical record will become increasingly sophisticated. Data mining software will be more useful and data aggregation tools more agile. There may have been a better time to be a pathologist; I just don't know of any.

The process of health care will look very different in years to come, as the population ages and molecular medicine coupled with powerful informatics transforms once-fatal diseases into manageable chronic conditions. Interspecialty dynamics are changing along with the tools available to us and none of the new instruments are likely to be "owned" by a particular specialty in the traditional sense. All of us will be looking for ways to employ powerful new modalities to improve our contributions to patient care.

At last count, 18 genomic biomarkers had been developed and associated with approved drug labels and new biomarker panels were in the pipeline. Diagnostic technologies are exploding and the companies that manufacture sophisticated instrumentation are merging and morphing at a mind-boggling rate. Imaging companies are buying laboratory diagnostics, and drug companies are buying imaging. In the February edition of its newsletter, "Inside the Lab Industry," Washington G-2 Reports identified 18 lab industry mergers and acquisitions valued at $3.1 billion in 2007.

Business publications are featuring long think pieces forecasting best investments in medical instrumentation; CEOs with MBAs are talking knowledgeably about proteomics. Professional distinctions long held close in the laboratory industry appear to be of little importance to investors, who are concerned only with what will work and at what profit.

What is most extraordinary is the scope of change in the biomedical industry, the number of companies whose investment strategies have influenced that change, and the speed with which new discoveries are being made and industry is investing in instrumentation that will allow us to apply new knowledge in research and patient care. The market moves, as the saying goes. Investment is not about science or policy; it's about opportunity. If new approaches and partnerships foster profit, expect accelerated change.

The business and lay press are covering advances in our field and we need to pay attention to what they are saying. Subscriptions to nonmedical publications that cover business news (such as the New York Times or the Wall Street Journal) are well advised. For example, in October, Harvard Business Review published a paper that examined how physicians, pharmaceutical companies, insurers, and government policymakers influence (and sometimes frustrate) the advance of personalized medicine. Good to read, better to share.

Opportunities to reach out to other specialists occur in traditional consultation, but a lot of peer education happens on the elevator and in the cafeteria. Our work is now so cutting edge that part of our task will be to engage colleagues in conversation about it, to encourage them to become comfortable about presenting and providing these tools to our patients. This is part of how we lead.

Molecular diagnostics is at the core of the personalized medicine vision, and personalized medicine is already changing the dynamic that governs partnerships between medicine and industry as well as pathologists and other specialists on the treatment team. We need to learn the language of industry, appreciate the subtleties of the market, and understand that independence, isolation, and control are neither realistic nor desirable in the emerging practice environment. We have an ownership stake in personalized medi­cine. To assert our place at the table, we should be chatting it up, everywhere, all the time. (A great place to get started, while I'm thinking of it, is the annual CAP Foundation Future­scape of Pa­thology Conference planned for June 6-8. This is certainly an excellent year to attend.)

I started this column by talking about the many ways in which our current position reminds me of skiing, but I left one out. Ski resorts usually post safety warnings, and this conversation brings one of those to mind. It's a cardinal rule on the slopes: People ahead of you have the right of way.

Science is opening the aperture to an amazing window of opportunity. But windows open and windows close. We'll want to keep that in mind.