Jan 30, 2015

Interviewer: Precision Medicine, some perspective next on The Scope.

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Interviewery: Dr. Will Dere is a Director for the Program for Personalized Health at University of Utah. It's a conversation that a lot of people are listening to right now, the President's Precision Medicine Initiative. I need some help here understanding how excited I should be about this.

Dr. Dere: I'm optimistic Interviewer and also realistic about what the President's speech and what precision medicine can offer. First of all, let's describe it a little bit because the term "precision medicine" maybe as a new initiative makes it sounds like what we have been doing has been imprecise medicine or the like. Just in terms of definitions, President Obama is really talking about the fact that we're in the midst of a biologic and genomic revolution, and our understanding of biology and the mechanism of disease is growing by leaps and bounds, and I find that extraordinarily exciting. Furthermore, the insights gained initially from the Human Genome Project and from our work subsequently has made the opportunities of finding disease causing genes, identifying patients at particular risk for disease and potentially preventing that, and also identifying new therapies directed against these disease causing genes also provides a very exciting time.

Interviewer: So the President decided now is the time to talk about this. Why? Why now? Why not five years ago? Why not 10 years from now? Why is now the time?

Dr. Dere: Well, now is the time because, again, there are so many advances. There are so many advances, and it's now the time because we can do better. We can do better in terms of maximizing the value of interventions in patients that we treat, whether these interventions could be with screening and looking at prevention also.
Another reason is the cost of health care is skyrocketing, and we need to improve the outcomes of our precious dollars in patients. So with increasing health care costs, if you just use the example of say in the field of oncology, one half of patients, who have a mutation in the ras oncogene, should not be getting an epidermal growth factor receptor antibody. Those types of things we can actually do better in terms of saving money.
The third thing is that with the President and the health care providers' emphasis on quality, we want to really make sure that we use all the tools possible. We've been talking about genetics, but all the tools possible to make sure that again the right patient is getting the right intervention, at the right time, for the right cost. We will be dependent on electronic health records, on important reminders, decision support technologies to really help physicians improve their prescribing and their interventions, and also tools in which patients can better understand, therapies and how to take therapies correctly and the like.

Interviewer: So it's $215 million. First of all, is that a substantial amount of money? I mean, it sounds big to me but . . .

Dr. Dere: Yes, it is a substantial amount of money, and it's going to take a lot more. I think it's going to take focus. It's going to take kind of a broader national commitment, both in the public and the private sector, to really do better for our citizenry.

Interviewer: You used to be in industry, so you're a businessman. Is this $215 million investment a good investment?

Dr. Dere: Yes.

Interviewer: It's going to really return dividends you feel?

Dr. Dere: Yes, but certainly having been in industry also, we have a higher calling also. I know there have been analyses done on the return on investment of the Human Genome Project, which it looks very, very promising. But ultimately we need to serve the public. Ultimately, whatever we spend and whatever we do needs to serve the public. Hence, I think the initiative is a great investment, and this is a great start because, again, we can do better within the field of health care to serve patients.

Interviewer: Is this our best chance to do better, do you feel?

Dr. Dere: It is a very important chance right now, and it's going to require continued energy and momentum.

Interviewer: Would you say precision medicine is a revolution in health care?

Dr. Dere: I think it's an evolution of health care.

Interviewer: Evolution. This is my final question. So as a regular person, what should I take away from this conversation? What mindset should I be in going forward?

Dr. Dere: I think you should be optimistic, because despite the limitations in budget and the like, there really is incredible expertise in this country in the field of biology and the life sciences, both in the public sector and the private sector. So there's incredible knowledge and I think a very strong will to do good things.
So I'm optimistic, and also our understanding of the science, the basis of what we're going to be doing is growing. So I'm optimistic, and we need perseverance and patience, because everything that looks so promising, there will be a lot of failures within this. But I believe that history has told us we're going to continue to have progress, sometimes by leaps and bounds, sometimes by little increments. I have heard the term "relentless incrementalism." That might be the way too, but I do believe that this is a wonderful opportunity to kind of reboot, to re-energize our commitment to science and to our citizens.

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