Laying the Groundwork for Precision Medicine

Precision medicine relies on input from multiple scientific disciplines, technologies and departments at Cedars-Sinai.

Cedars-Sinai is preparing to advance the institution to the forefront of the next healthcare revolution: precision medicine. Using the latest medical discoveries, this revolution seeks to tailor disease treatments and prevention strategies to each unique individual.

"Precision medicine at Cedars Sinai is a partnership between scientists, clinicians and industry," Dermot McGovern, MD, PhD, quoting from the initiative's mission statement, told 30 department leaders March 17 at a meeting at the Advanced Health Sciences Pavilion. "We will drive the development of the newest technology and best research, coupled to the finest clinical practice, to rapidly deliver precise and personalized healthcare solutions."

McGovern directs a six-member core group that is laying the groundwork for the official launch of the Precision Medicine Initiative on Sept. 16. (For profiles of the members, please see "Meet the Precision Medicine Leaders.")

The concept of precision medicine, sometimes called personalized medicine, has been around for a long time, McGovern explained. To prove his point, he quoted from Leo Tolstoy's 19th century novel War and Peace: "No disease suffered by a live man [or woman] can be known, for every living person has his own peculiarities and always has his own peculiar, personal, novel, complicated disease, unknown to medicine." (McGovern added the bracketed phrase.)

But scientific advances in the past quarter-century have propelled precision medicine to a higher plane. These advances include the sequencing of the human genome, plus new insights into our bodies' complex chemical activity (metabolomics), protein function and structure (proteomics) and billions of microorganisms (the microbiome).

With the help of ever-faster computing, all the so-called big data generated by these discoveries can be combined into a comprehensive profile of an individual's biology. Using mobile applications and sensors, patients can even generate their own data, such as heart rates and blood-glucose levels, at home — an advance called "near-patient technologies."

"We strongly believe that we are developing an innovative and very significant initiative at Cedars-Sinai," McGovern said. The initiative's mission statement predicts that "scientific advances derived from 'big data' will provide the therapeutic and diagnostic tools that our clinicians need to significantly impact patient care." Besides improving health, these advances can ultimately provide more cost-effective healthcare to the community, McGovern noted.

In one example, Sumeet S. Chugh, MD, medical director of the Heart Rhythm Center in the Cedars-Sinai Heart Institute, said that potentially, a heart patient could monitor his or her own vital signs, such as administering an electrocardiogram. That data, combined with personal health information on file, could enable the patient to avoid making an unnecessary 911 call for symptoms that might not require emergency care.

In remarks at the March 17 meeting, Shlomo Melmed, MD, executive vice president, Academic Affairs, and dean of the medical faculty, said Cedars-Sinai's flexible organizational structure, combined with its research talent and large-scale healthcare delivery operation, make it well-qualified to achieve national prominence in precision medicine. "Now is the time to grab this opportunity," he said.

Cedars-Sinai already is having an impact in the field. It was selected by the White House to participate in a Feb. 25 summit in Washington marking the one-year anniversary of President Barack Obama's Precision Medicine Initiative. It is one of three California institutions invited by the California Initiative to Advance Precision Medicine to participate in a seminar on the topic this week (March 21-24) at the American Medical Informatics Association meeting in San Francisco.

The next steps for Cedars-Sinai's leaders include assessing the skills and resources needed to support precision medicine; deciding which problems to tackle first; maximizing collaborations between internal scientific groups and industry partners; and selecting criteria for initial projects. Breakout sessions at the March 17 meeting were devoted to each of these topics.

Despite the challenges ahead, leaders of the Precision Medicine Initiative at Cedars-Sinai voiced optimism at the meeting. "Today is a very special day. Today is the day we are going to break some barriers and drive the next generation of therapies and diagnoses," said Jennifer Van Eyk, PhD, director of the Advanced Clinical Biosystems Institute and of Basic Science Research in the Barbra Streisand Women's Heart Center. She is co-director of the Precision Medicine Initiative.