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Preparing to launch personalized medicine
TRAVIS AIR FORCE BASE, Calif.—The United States Air Force has brought aboard the Coriell Institute for Medical Research to enroll 2,000 active-duty healthcare providers as part of a broad-based program designed to prepare for and enable the use of personal genomic information in clinical practice.
The partnership with the Coriell Institute is part of the Air Force's PC2-Z longitudinal study, which aims to advance and eventually implement genome-informed personalized medicine.
Better technology and less expensive screening methods provide the impetus for the Air Force Medical Service (AFMS), as well as other medical providers, to begin to understand the ramifications of personalized genomic information becoming readily available.
"Having your own personal genome analyzed is becoming cheaper than an MRI—we're approaching a cost of around $1,000 to interpret a person's genome," says Michael Christman, president and CEO of the Coriell Institute. "Soon it will be $100. As the technology becomes cheaper than many medical procedures commonly employed today, we'll begin to see a flood of them in clinical practice."
The Coriell Institute is a nonprofit organization based in Camden, N.J., dedicated to the pursuit of genome-informed medicine. Its Coriell Personalized Medicine Collaborative (CPMC) is a research study that employs an evidence-based approach to determine the efficacy of using personal genome information in health management and clinical decision-making.
The Air Force's PC2-Z study will examine the real-world implications of using personal genetic information in clinical decisions. Participating Air Force Medical Service personnel will screen patients for genetic markers of risk factors for diseases such as obesity, cancer and other complex illnesses. This information will be shared and discussed with patients in an effort to determine whether lifestyle modification or behavior changes—such as eating healthier foods, maintaining lower body weight or increasing physical activity—correlate with receiving news of increased risks.
The study's participants must also grapple with the myriad social, ethical, legal and scientific issues related to personalized genetic screening. The widespread availability of personalized genomic information is likely to be complicated by misperceptions and perceived risks of receiving personal genetics. In a past study that Coriell conducted in conjunction with the University of Pennsylvania, patients feared learning something they didn't want to know, such as predisposition for Alzheimer's disease or other incurable illnesses. To combat this, researchers put results up securely online and allowed patients to then choose to look at some or all of the results. Some patients—roughly 11 percent in Coriell's previous study—believed that identified risk factors could be "cured" using gene therapy, which is not the case. Medical providers must be prepared to encounter these kinds of challenges and others.
"We're teaching the teachers who can make decisions that affect the more than 2 million people covered by the Air Force Medical Service," says Christman.
"Application of personal genetic data is finally coming out of the realm of textbooks and PowerPoints and into reality," says Maj. Carlos Maldonado. "This study is not just about having it, but making sense of it in an intelligent, factual way."
"The study also provides an experiential learning opportunity for our medical personnel so that they have first-hand experience with genetic research," says Lt. Col. Cecili Sessions, chief of AFMS Personalized Medicine.
Having launched in 2007, the CPMC had already enrolled 6,000 people in its own personal genetic information study by the time the Air Force called for applicants for a partnership to help it execute the PC2-Z study. The Coriell institute had become a leader in the field of personalized medicine, and it applied to the PC2-Z partnership because its team recognized that the organization's interests aligned closely with those of the Air Force on this project. The Air Force selected Coriell from among the applicants because of its impeccable reputation and long history of helping to provide scientific advances in the field, alongside a track record of maintaining strict confidentiality of personal data, according to Sessions.
"When we looked to academia and industry for advances in the evidence base directing personalized care, we recognized Coriell as possessing the expertise, infrastructure and leadership to execute the clinical arm of the PC2-Z study," said Surgeon General of the Air Force Lt. Gen. Charles B. Green in a September press release announcing the collaboration.
The CPMC was named one of the top 10 research projects to watch by MIT Technology Review in 2010.