Healthcare CIOs Need Personalized Medicine

Pablo Valerio, International Business & IT Consultant | 9/24/2013 | 20 comments

Pablo Valerio
Aided by big-data and cloud computing, "personalized medicine" is enabling doctors and researchers to evaluate the potential of existing drugs in different individuals and make better clinical decisions.

One of the best selling prescription drugs in the world is Clopidogrel, mostly selling under the trade name Plavix. Clopidogrel is prescribed to most patients with risk of blood clots, and to all patients receiving a stent. The problem with Clopidogrel -- as with many other drugs -- is the variable effects in patients: It works well for some but in others has almost no effect. The usual approach of physicians is to increase the dose, until they find that the drug doesn't work at all and then try another one.

But now we know that a specific gene, CYP2C19, is responsible for metabolizing clot-dissolvent medication such as Clopidogrel. The impact is enormous. Now most patients who are candidates to receive a stent are tested for variants of the CYP2C19 gene, with physicians seeking alternative procedures for the ones who can't metabolize Clopidogrel.

In order to differentiate the variants of those genes, it is necessary to perform Genome-Wide Association Studies (GWAS) on a significant number of affected individuals, with full genome sequencing performed to identify the responsible genes. But, to map the results and cross reference all genomic data, massive computational power is required. While the speed of genome sequencing has increased 1000-fold in the past ten years and the cost is approaching the $1,000 mark (the first genome took 13 years and cost $2.7 billion), cross-referencing all that information is still a huge challenge. A typical genome sequence of an individual yields around 3 million sequence variants compared with the reference genome.

This is where big-data and cloud computing are indispensable tools for researchers. The combined power of virtual machines and the storage capacity can do the work much faster today than in 2006, when the first GWAS were performed.

In the near future, when the genome of each person will form part of their Electronic Health Records, researchers would be able to perform GWAS over a (hopefully anonymized) massive database of patients with the click of a mouse, and forecast drug interactions before the pharmaceutical has been produced.

Almost 7 percent of hospitalizations in the US each year are related to adverse drug reactions resulting in hundreds of deaths. GWAS and pharmacogenomics can reduce the number of bad prescriptions, but the information needs to be in the hands of the patients and physicians.

That, of course, is where the CIO comes in. With CIOs hard-pressed to meet the goals of Meaningful Use, maintain security and privacy with an increasing number of threats, and respond to the very real HIPAA issues with BYOD, the last thing CIOs need is another priority. However, bringing a robust DNA sequencing and storage capability to your hospital is a must. The ability to provide your doctors with the information that will allow them to make safer, more effective decisions, reducing risk and costs for your hospital while providing improvements in patient care and revenue, is priceless. Of course, those are the real goals of any healthcare CIO.

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Susan Nunziata   Healthcare CIOs Need Personalized Medicine   10/22/2013 2:00:35 PM
Re: Important with aging population
@Pablo: It is really encouraging, though also a little scary. I can envision a time, in the for-profit health insurance business that exists in the U.S., where a health insurer will insist on this kind of testing before approving a prescription for a patient.

It all depends on where the power falls, and how the practice of pharmacogenics is integrated with the business practices of the vast healtcare and pharmaceutical business.
Pablo Valerio   Healthcare CIOs Need Personalized Medicine   10/2/2013 12:54:19 PM
The guaranteed-to-succeed model
@Sara, you're right about patent protection. Some drugs such as Lipitor, which lost its propietary protection two years ago, was generating $13 billion in sales per year.

One thing big pharma has been doing is buying generic drug manufacturers to keep profiting from their drugs, but they can't stop others to produce it.'

One of the problems with pharmacogenomics for big pharma is how to offset the developing costs with a smaller number of patients. If we know in advance that a particular drug only works with 10% of the patients suffering a particular condition, then it is not given to the other 90%, making the drug extremely expensive for those patients and their insurance providers.

Making Personalized Medicine Pay

Some companies are starting to offer a guaranteed-to-succeed model for new expensive drugs. They are asking for conditional approval from the FDA and EMC promising not to charge anything if the drug doesn't help the patient significantly with their condition.
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Pablo Valerio   Healthcare CIOs Need Personalized Medicine   10/2/2013 12:35:31 PM
Re: Important with aging population
@Susan, pharmacogenics can also save millions to national health services and Medicare.

Just imagine the amout of money, and potential harmful side-effects, that could be saved if people with chronic conditions are tested, and their prescriptions adjusted. Many of the patients are taking drug combinations just to make sure one works.

If doctors know that a patient could not benefit from Clopidogrel, why give them an expensive drug such as Plavix. The cost of the genomic test is offset with a few weeks of medication cost.
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Susan Nunziata   Healthcare CIOs Need Personalized Medicine   9/30/2013 7:54:32 PM
Re: Important with aging population
@kstaron: If we're not there yet, I imagine that is where we are headed and it's truly encouraging to think that we could be fitted with a personalized prescription regimen that docters can give us with confidence knowing they'll be able to achieve the desired results.

Having experienced adverse reactions to certain medications myself, I can attest that I'll be first in line to try this out as it becomes widespread.
Susan Nunziata   Healthcare CIOs Need Personalized Medicine   9/30/2013 7:52:21 PM
Re: Re : Healthcare CIOs Need Personalized Medicine
@Anand: that's an appealing scenario from a patient's point of view, especially the idea of being able to access that data as needed, say in the case of an emergency.

Will this open us up to the possibly of DNA-fraud? As with identity fraud, could there someday be value in stealing someone's DNA profile?

Sara Peters   Healthcare CIOs Need Personalized Medicine   9/29/2013 6:33:39 PM
Re: Personalized medicine FTW
@jastro  I think it's all of the above. But I also think it's with technology companies doing a better job at creating the computing power necessary for the genetic researchers to crunch all that genomic data.
Sara Peters   Healthcare CIOs Need Personalized Medicine   9/29/2013 6:26:34 PM
Re: Personalized medicine FTW
@Taimoor  I agree. Speaking personally, I know it would be a big comfort to me if medical professionals could access my medical info when I can't speak for myself. It's one thing if there's an emergency and you get taken to an ER at a hospital that knows you -- it's another thing if you're traveling and you're taking to a hospital that doesn't know a thing about you.
Sara Peters   Healthcare CIOs Need Personalized Medicine   9/29/2013 6:20:42 PM
Re: Healthcare CIOs Need Personalized Medicine
@Shamika  I'm not an expert on this, but I believe that one of the troubles with pharmaceuticals is that the companies that create the drugs only have a certain amount of time to sell the drug exclusively before generic versions come out. So sometimes they rush to get something out as soon as possible. Of course it's also impossible to test out EVERY single circumstance -- just like in IT test/dev shops it's impossible to test out every single possible configuration.
Anand   Healthcare CIOs Need Personalized Medicine   9/27/2013 4:03:52 AM
Re : Healthcare CIOs Need Personalized Medicine
Basically every person to be born into this world in the near future would have a personal cloud storage space to his name, which will be dedicated to storing information about the genome and other health related information, which can be shared from medical store to medical store and from hospital to hospital just like transferring records of a patient from one room to another.

Healthcare CIOs are frequently tasked with making the runtime of processes in a hospital minimal and they are responsible for a smoother and faster operation of the hospital.
kstaron   Healthcare CIOs Need Personalized Medicine   9/26/2013 10:44:48 AM
Important with aging population
I like the idea that eventually my doctor can cross reference my DNA with the drug he wants me on and can make sure I'm not going to have an allergic reaction or not be able to metabolize something based on genes. With the aging population making sure drugs do their job and don't react poorly with an individual is going to be even more inportant as people have to take more and more medicines. Is this means of personalized medicine able to identify many reactions to drugs like adverse reactions to statins or such?
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